Conduction system pacing in difficult cardiac anatomies: Systematic approach with the 3D electroanatomic mapping...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Restoring physiological cardiac electrical activity is vital for patients with conduction disease.
• Conduction system pacing (CSP) offers a valuable therapeutic option but faces technical challenges in complex anatomies.
• 3D electroanatomical mapping (3D-EAM) enhances CSP precision and reduces fluoroscopy use.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of systematic 3D-EAM guided CSP.
• Focus on challenging anatomical scenarios including dilated atria, cardiomyopathies, and failed biventricular implants.
• Assess the utility of 3D-EAM in difficult pacing anatomies.

Main Methods:

• Forty-three patients with standard pacing indications and complex anatomies were included.
• 3D-EAM was used to reconstruct key cardiac structures (right atrium, His cloud, AV septum).
• His bundle pacing (HBP) was the primary target, with left bundle branch area pacing (LBBAP) as an alternative.

Main Results:

• CSP was successful in 86% of patients (15 HBP, 22 LBBAP).
• Mean procedural time was 98 minutes with 7 minutes of fluoroscopy.
• Achieved favorable pacing parameters: threshold 1.2V, sensing 11.4mV, impedance 736Ω; paced QRS narrowed to 114ms.

Conclusions:

• 3D-EAM accurately defined cardiac structures, effectively guiding CSP in complex cases.
• The study demonstrated an 86% procedural success rate for CSP in challenging anatomies.
• 3D-EAM facilitated reproducible and satisfactory CSP outcomes with acceptable procedural times.