Multiple electrode leads facilitate left bundle branch area pacing: A concept evaluation study.

Area of Science:

• Cardiovascular Electrophysiology
• Medical Device Development

Background:

• Left bundle branch area (LBBA) lead placement traditionally uses single-electrode pacing with ECG guidance.
• Transeptal advancement is a key step in current LBBA lead implantation.

Purpose of the Study:

• To develop and evaluate a multielectrode lead (MEL) for improved LBBA pacing.
• To compare MEL performance against clinically relevant lumenless leads (LLLs).

Main Methods:

• A 3D-printed MEL with 3 circumferential electrode sites was developed.
• MELs and LLLs were implanted in canine hearts (n=4) at up to 3 LBBA sites.
• Impedance, pacing threshold, and QRS duration were recorded and compared.

Main Results:

• MEL and LLL showed similar impedance and capture voltages.
• MEL more frequently resulted in narrower QRS durations (82 ms vs 114 ms for LLL, P=.03).
• MEL pacing evoked QRS morphology changes and durations similar to sinus rhythm.

Conclusions:

• MELs more frequently elicited ECG markers of conduction system capture.
• The findings suggest MELs may streamline implantation and reduce lead repositioning.
• MELs show potential to advance conduction system pacing strategies.