Safety assessment of coronary arteries during left bundle branch area pacing
Qiling Kong1, Huolong Chen2, Juan Hua1
1Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Rd, East-lake District, 330006, Nanchang, Jiangxi, China.
Insights
Left bundle branch area pacing (LBBAP) is safe, with electrodes positioned away from coronary arteries. Electrode placement in the posterior-mid zone enhances safety and left bundle branch capture.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- Assessing the safety of Left Bundle Branch Area Pacing (LBBAP) is crucial for its clinical adoption.
- Understanding the spatial relationship between pacing electrodes and coronary arteries is key to preventing complications.
- A nine-partition grid method was employed to evaluate electrode proximity to coronary arteries.
Purpose of the Study:
- To evaluate the safety of LBBAP by measuring the distance between pacing electrodes and coronary arteries.
- To identify optimal electrode placement zones for safe LBBAP implantation.
- To assess potential cardiac injury markers post-LBBAP.
Main Methods:
- Retrospective analysis of 50 patients undergoing LBBAP and coronary angiography (January 2019 - October 2020).
- Utilized fluoroscopic images and a nine-partition grid to measure electrode-coronary artery distances.
- Monitored ECG ST-T segment changes, serum troponin, and myocardial enzymes pre- and post-procedure.
Main Results:
- Pacing electrodes were primarily located in posterior-middle, median, posterior inferior, and middle inferior zones.
- Average distances from electrode tips to LAD, PD, and PL arteries were 19.69±8.72 mm, 26.09±8.02 mm, and 21.11±7.86 mm, respectively.
- No significant coronary artery injury observed; however, elevated troponin and ECG ST-T changes were noted.
Conclusions:
- LBBAP electrodes can be safely implanted across a wide range, particularly within the defined rectangle of PM, M, PI, and MI zones.
- Posterior-mid zone placement optimizes left bundle branch capture and coronary artery safety.
- Potential risk of left anterior descending artery injury is higher compared to the posterior descending artery.
Background:
This study aimed to assess the safety of left bundle branch area pacing (LBBAP) by measuring the distance from the tip of the electrode to the nearby coronary artery with a nine-partition grid method.
Methods:
From January 2019 to October 2020, patients who underwent LBBAP and postoperative coronary angiography in the Second Affiliated Hospital of Nanchang University were included in the study. The patients' fluoroscopic images of LBBAP and coronary angiography were collected and analyzed. Changes in the ST‑T segment in the electrocardiogram (ECG), serum troponin, and myocardial enzyme profiles were observed before and after the LBBAP procedure.
Results:
A total of 50 patients were included in this study, of whom 46 patients underwent implantation with a pacemaker and 4 patients received an implantable cardioverter defibrillator (ICD). The pacing electrodes were confined to the posterior-middle (PM), median (M), Posterior inferior (PI), and middle inferior (MI) positions of the two-dimensional nine-square grid or in the junction area of the above positions, and were concentrated in the rectangle formed by the line of the center points of the four positions. The average vertical distances from the electrode tip to the left anterior descending branch artery (LAD), posterior descending branches (PD) and the left posterior ventricular branches (PL) were 19.69 ± 8.72 mm, 26.09 ± 8.02 mm, and 21.11 ± 7.86 mm, respectively; the minimum was 5.28 mm, 9.51 mm, and 8.69 mm, respectively. Coronary angiography in all patients showed no significant injury to the ventricular septal branch; however, we observed elevated serum troponin and changes in ST‑T segment in ECG.
Conclusion:
The study demonstrates that pacing electrodes in LBBAP can be safely implanted over a wide range. Coronary arteries are likely to be safe when the pacing electrodes are located within the rectangle formed by the line connecting the PM, M, PI, and MI zone centroids. The left bundle branch can be quickly captured and the safety of the coronary artery can be improved by locating the electrode in the posterior-mid zone. The potential risk of injury to the LAD from the electrode is greater compared with the PD.
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