Left Bundle Branch Pacing of His-Purkinje Conduction System: Initial Experience
Alexander Romeno Janner Dal Forno1, Caique M P Ternes1, João Vítor Ternes Rech1
1Hospital SOS Cardio , Florianópolis , SC - Brasil.
Insights
Left bundle branch stimulation offers a safe and effective alternative to conventional pacing, reducing risks of heart failure and atrial fibrillation. This His-Purkinje system stimulation method demonstrates high success rates and favorable electronic parameters in patients.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Conventional right ventricular pacing is linked to increased risks of atrial fibrillation and heart failure.
- Left bundle branch (LBB) stimulation of the His-Purkinje system presents a potential method to mitigate these adverse outcomes.
Purpose of the Study:
- To evaluate the intraoperative outcomes, electrocardiographic data, and initial clinical follow-up of patients undergoing LBB stimulation.
- To assess the safety and feasibility of LBB stimulation as a pacing strategy.
Main Methods:
- Retrospective analysis of 52 consecutive patients who underwent LBB stimulation.
- Evaluation of electronic pacing parameters, procedure duration, and early complications.
Main Results:
- A high success rate of 50 out of 52 procedures (96.2%) was achieved.
- Significant reduction in QRS duration from 146 ms to 120 ms, indicating improved ventricular conduction.
- Low stimulation thresholds and adequate R-wave amplitudes were observed, alongside manageable procedure and fluoroscopy times.
Conclusions:
- Left bundle branch stimulation is a safe and feasible technique for cardiac pacing via the His-Purkinje system.
- The procedure demonstrates a high success rate with favorable electronic parameters and efficient procedural metrics.
Background:
Conventional right ventricular pacing increases the risk of atrial fibrillation and heart failure in pacemaker patients. Stimulation of the left bundle branch (LBB) of the His-Purkinje system can prevent the unwanted outcomes of right ventricular pacing.
Objective:
To retrospectively analyze the intraoperative outcomes, electrocardiographic and clinical data from the initial follow-up of patients submitted to stimulation of the LBB.
Methods:
The electronic parameters of the implant and of possible early complications of 52 consecutive patients submitted to stimulation of the conduction system were evaluated. The adopted significance level was 0.05.
Results:
Fifty-two patients underwent left bundle branch stimulation, with 50 successful procedures; 69.2% of the patients were male, and the median and interquartile range of age at the time of implantation was 73.5 (65.0-80.0) years. The pre-implant QRS duration was 146 (104-175) ms and 120 (112-130) ms after the procedure. The left ventricle activation time was 78 (70-84) ms. The R-wave amplitude was 12.00 (7.95-15.30) mV, with a stimulation threshold of 0.5 (0.4-0.7) V x 0.4 ms and impedance of 676 (534-780) ohms. The procedure duration was 116 (90-130) min, and the fluoroscopy time was 14.2 (10.0-21.6) min.
Conclusion:
Cardiac stimulation of the His-Purkinje conduction system through the stimulation of the left bundle branch is a safe and feasible technique. In this study, it showed a high success rate, with low procedure and fluoroscopy periods, achieving adequate electronic measurements.
Related Concept Videos
01:20Conduction System of the Heart
This system relies on the unique properties of nodal and Purkinje cells:...
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias
01:13The Cardiac Cycle
The Process
Electrical signals—sent from the sinoatrial (SA) node in the right atrial wall to the atrioventricular (AV) node between the right atrium and right ventricle—cause both atria to simultaneously contract. When the signal reaches the AV node, it pauses for approximately a tenth of a second, allowing the atria to contract and...
01:19Electrophysiology of Normal Cardiac Rhythm
01:15Dysrhythmias I: Introduction
01:25Correlation between ECG and Cardiac Cycle
A cardiac action potential originates in the SA node and spreads throughout the atria and the AV node in approximately 0.03 seconds. This results in the P wave in an ECG and triggers atrial contraction. The action potential is then briefly slowed at the AV node, allowing the atria to contract and fill the ventricles with blood before...