Left bundle area pacing: Guiding implant depth by ring measurements.

Area of Science:

• Cardiology
• Electrophysiology
• Medical Device Technology

Background:

• Current criteria for successful left bundle area pacing (LBAP) rely on lead tip measurements and are not well-established.
• Lead ring measurements during LBAP have not been extensively studied for predicting implant success.

Purpose of the Study:

• To investigate the dynamics of pacing parameters during both successful and unsuccessful lead implant attempts for LBAP.
• To determine if lead ring measurements can predict lead depth and implant success.

Main Methods:

• Retrospective review of procedural, echocardiographic, and pacing data from 73 patients undergoing LBAP with SelectSecure 3830 leads.
• Analysis of lead depth and lead-septal angle using fluoroscopy and septal contrast.
• Correlation of pacing parameters (tip and ring impedance, unipolar ring threshold) with lead depth and implant success.

Main Results:

• Ring impedance increased significantly during successful LBAP attempts compared to unsuccessful ones (P = .039).
• Higher ring impedance correlated with a wider lead-septal angle (P = .036), while tip impedance showed no such association.
• Unipolar ring threshold correlated with lead implant depth (P = .029), unlike tip impedance measurements.

Conclusions:

• Lead ring pacing parameters are more predictive of lead progress and depth during LBAP than traditional tip measurements.
• Ring impedance measurements can potentially determine lead depth and lead-septal angle, possibly eliminating the need for contrast injection.