Observations of interventricular septal behavior during left bundle branch pacing.

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Left bundle branch pacing (LBBP) is an advanced pacing technique requiring deep septal lead deployment.
• Successful septal penetration depends on factors like septum texture, rotation speed, and operator skill.

Purpose of the Study:

• To evaluate lumenless lead behavior during rapid rotations in LBBP.
• To assess the interventricular septum's (IVS) physiological response during LBBP procedures.

Main Methods:

• Retrospective analysis of 255 patients undergoing LBBP between January 2021 and December 2022.
• Assessment of lead movement within the IVS using lead traverse time and observation of lead-septum interaction.

Main Results:

• Procedural failure occurred in 7.9% of patients, with inability to penetrate the septum and lead dislodgement being common issues.
• Three distinct IVS responses to lead deployment were identified: normal/firm (93.7%), soft/cheesy (3.5%), and scarred (2.8%).
• The soft/cheesy septum (Type-II) was associated with lead hyper-movement and perforation, while scarred septa (Type-III) impeded penetration.

Conclusions:

• LBBP lead deployment success is influenced by IVS characteristics.
• A soft/cheesy septum presents a higher risk of lead hyper-movement and potential dislodgement, even in patients without structural heart disease.
• Understanding these septal responses is crucial for optimizing LBBP implantation techniques and patient outcomes.