Lead Performance and Echocardiographic Outcomes for Delayed Bundle Capture Loss During Conduction System Pacing

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Conduction system pacing (CSP) mitigates adverse hemodynamic effects of conventional ventricular pacing.
• Limited data exists on lead performance and echocardiographic outcomes for delayed bundle capture loss during CSP.

Purpose of the Study:

• Evaluate the incidence of complete bundle capture loss or correction failure during CSP.
• Assess subsequent clinical outcomes and the impact of lead revision.

Main Methods:

• Screened patients with successful CSP lead implantation for ventricular pacing or CRT.
• Identified reasons for complete loss of capture or left bundle branch block (LBBB) correction failure.
• Analyzed clinical outcomes and echocardiographic data post-intervention.

Main Results:

• Nine out of 2636 patients experienced complete loss of bundle capture or LBBB correction.
• Loss attributed to unexplained causes (6), dislodgement (1), surgical damage (1), and malfunction (1).
• Lead revision in 6 CRT patients improved LVEF from 40.6% to 59.1%; 3 AV block patients without revision had stable function.

Conclusions:

• Complete capture loss during CSP is infrequent.
• Recapturing/recorrecting the bundle significantly improves cardiac function in CRT patients.
• CSP demonstrates favorable lead performance and clinical outcomes.