Closed loop stimulation in left bundle branch area pacing
Gabriele Dell'Era1, Chiara Ghiglieno1, Federica De Vecchi1
1Clinica Cardiologica, Dipartimento Toraco-Cardio-Vascolare, Ospedale Maggiore della Carità, Novara, Italy.
Insights
Closed Loop Stimulation (CLS) effectively adjusts heart rate (HR) with left bundle branch area pacing (LBBAP), showing similar HR distribution and mean HR compared to DDD pacing. This indicates CLS is a viable rate-responsive option for LBBAP.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Closed Loop Stimulation (CLS) is a rate-responsive pacing algorithm using intracardiac impedance.
- Its efficacy in conduction system pacing, specifically left bundle branch area pacing (LBBAP), remains uninvestigated.
- Chronotropic incompetence necessitates rate-responsive pacing solutions.
Purpose of the Study:
- To evaluate the rate-responsive performance of CLS in patients undergoing LBBAP.
- To assess if CLS with LBBAP can achieve appropriate heart rate (HR) distribution in daily life.
- To compare CLS-LBBAP with conventional DDD pacing in LBBAP patients.
Main Methods:
- Retrospective study comparing 24 patients with CLS-LBBAP and 19 patients with DDD-LBBAP.
- Data collected via device interrogation with a minimum 30-day follow-up.
- Analysis of cumulative HR distribution and mean HR.
Main Results:
- CLS-LBBAP showed a higher percentage of atrial pacing compared to DDD-LBBAP (58% vs. 13%, p=0.001).
- CLS-paced beats were observed across all heart rate frequency bins.
- No significant difference in beat distribution (p=0.643) or mean HR (72 bpm vs. 73 bpm, p=0.615) between groups.
Conclusions:
- CLS effectively modulates pacing rates in LBBAP across a wide frequency range.
- The lead position in LBBAP does not negatively impact CLS performance.
- CLS is a suitable rate-responsive algorithm for LBBAP, offering comparable HR control to DDD pacing.
Introduction:
Closed Loop Stimulation (CLS) is a rate-responsive algorithm that adjusts heart rate (HR) based on changes in intracardiac impedance measured from the right ventricle lead. However, the use of CLS in conduction system pacing has not been investigated. In this retrospective study, we aimed to assess whether CLS with left bundle branch area pacing (LBBAP) can generate an appropriate distribution of HR in daily life.
Methods And Results:
Our study included 24 patients with CLS pacing and chronotropic incompetence, comparing them with 19 patients receiving DDD pacing, all with LBBAP. Cumulative HR distribution charts were generated using data from a single device interrogation with a minimum follow-up period of 30 days. In DDD-CLS mode, there was a higher percentage of atrial pacing compared to DDD mode (median 58% [interquartile range 29%-83%] vs. 13% [10%-26%], p = .001), and CLS-paced beats were present across all frequency bins. The distribution of beats between the groups was similar (p = .643), resulting in comparable mean HR (72 bpm [70-77] vs. 73 bpm [65-75], p = .615).
Conclusions:
In the context of LBBAP, CLS effectively modulates pacing rates over a wide frequency range. This lead position does not adversely affect the rate-responsive performance of the algorithm.
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