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Occurrence of ventricular septal perforation in patients with permanent left bundle branch pacing followed up using
Qiaoyuan Li1, Wenlong Dai1, Dongping Fang1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Left bundle branch pacing (LBBP) is a safe and effective treatment for bradycardia. Echocardiography and CT scans accurately detect and monitor potential complications like septal lead perforation post-procedure.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Bradycardia management often requires pacing.
- Left bundle branch pacing (LBBP) offers an alternative to traditional pacing methods.
- Assessing the safety and structural changes associated with LBBP is crucial.
Purpose of the Study:
- To evaluate short-term cardiac changes following LBBP.
- To specifically investigate the incidence of ventricular septal perforation (VSP) post-LBBP.
- To assess the utility of echocardiography and computed tomography (CT) in monitoring LBBP.
Main Methods:
- A prospective study of 33 patients with atrioventricular block undergoing LBBP.
- Serial electrocardiography, pacing parameters, and echocardiographic measurements were performed over 24 months.
- Echocardiography and CT were used to detect interval VSP.
Main Results:
- LBBP was successfully implanted in all patients with stable pacing parameters.
- No VSP occurred immediately post-procedure.
- Four patients (12%) developed septal lead perforation by 1-month follow-up, confirmed by echocardiography and CT.
- These perforations did not significantly affect pacing thresholds or impedance over time.
Conclusions:
- Permanent LBBP is a safe and feasible option for bradycardia patients.
- Echocardiography and CT are valuable tools for monitoring cardiac structure and function after LBBP, including the detection of lead perforation.
Objective:
To explore short-term changes after left bundle branch pacing (LBBP) using echocardiography and computed tomography (CT), especially for postoperative ventricular septal perforation.
Methods:
Between January and September 2019, 33 patients with atrioventricular block underwent LBBP at Beijing Anzhen Hospital. All the patients were evaluated using electrocardiography, pacing, parameters and echocardiographic measurements, including for major complications, during the 1, 3, 6, 12 and 24-month follow-up. Interval perforations were examined during a 1-month follow-up echocardiogram and CT.
Results:
Left bundle branch pacing was successfully performed in 100% (33/33) of patients. The mean seizure threshold was stable and unchanged postoperatively at the 1, 3, 6, 12 and 24-month follow-up. The paced QRS duration of the LBBP was 119.72 ± 2.53 ms and <130 ms in all patients. Unipolar impedance during the procedure was higher than 500 Ω (662.00 ± 181.50 Ω). No ventricular septal perforation occurred at the end of the procedure. At the 1-month follow-up, two patients reported transthoracic echocardiography, with CT revealing septal lead perforation. Through CT, two other patients were found to have septal lead perforation, and echocardiography indicated that the pacing lead had penetrated the interventricular septum and entered the left subendocardium. At the 1, 3, 6, 12 and 24-month follow-up, these four patients exhibited no significant increase in pacing threshold or impedance (p > .05). No ventricular thrombus or stroke was detected.
Conclusion:
Permanent LBBP is safe and feasible in patients with bradycardia. Echocardiography and/or CT can more accurately evaluate changes in cardiac structure and function after LBBP.
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