Initial Experience With Implantation Left Bundle Branch Pacing Leads Without a Dedicated Three-Dimensional Sheath

Left bundle branch area pacing (LBBAP) has emerged as an alternative to cardiac stimulation via right ventricular pacing and cardiac resynchronization therapy using coronary sinus leads. The approach utilizes dedicated three-dimensional guiding catheters for lead placement. Our objective was to evaluate the feasibility and safety of a simplified approach of implantation of an LBBAP electrode without a dedicated guiding catheter.

This was a prospective single-center proof-of-concept evaluation. Patients with an indication for dual-chamber pacemaker implantation were consecutively enrolled. All patients received ventricular lead placement with a commercially available stylet-driven pacemaker lead. LBBAP was attempted without the use of a dedicated guiding catheter but with the help of a manually three-dimensionally pre-curved stylet.

A total of 24 patients were analyzed. Procedure and fluoroscopy durations were 61 ± 12 min and 7.4 ± 3.9 min, while LBBAP lead placement was successful in 19 patients (79%). In these patients, the V6-R-wave peak time was 74 ± 11 ms, the V1V6 interpeak interval was 51 ± 11 ms, and QRS width during unipolar stimulation was 123 ± 14 ms. No complications attributed to the transseptal route of the pacing lead occurred. After a mean follow-up of 104 ± 20 days, there was no significant change in QRS widths (123 ± 15 ms, p = 0.94), V6-R wave peak time (70 ± 11 ms, p = 0.3), and V1V6 interpeak interval (45 ± 10 ms; p = 0.12).

Implantation of an LBBAP electrode without the use of a dedicated three-dimensional sheath is feasible and safe in a high proportion of patients. Further studies are necessary to define the impact of this technique for potential use in clinical routine.