A Novel Three-dimensional Mapping Device to Guide Lead Placement for Left Bundle Branch Area Pacing.

Area of Science:

• Cardiology
• Medical Imaging
• Electrophysiology

Background:

• Left bundle branch area pacing (LBBAP) is a physiologic pacing technique requiring precise lead placement.
• Traditional 2D fluoroscopy presents challenges in accurately guiding leads to the left bundle branch area (LBBA).
• Navik 3D navigation software offers potential for enhanced 3D visualization during cardiac procedures.

Purpose of the Study:

• To evaluate the feasibility of using Navik 3D navigation software to assist with lead placement during LBBAP procedures.
• To assess Navik 3D's ability to identify lead location, plane, and depth within the right ventricular septum for LBBA targeting.

Main Methods:

• Prospective, observational, single-center study involving 14 patients undergoing LBBAP.
• Utilized Navik 3D software to visualize the LBBA, right ventricular septum, and lead position in 3D.
• Overlaid 3D images onto real-time, gated fluoroscopic views for intra-procedural guidance and lead repositioning.

Main Results:

• Successful implantation of LBBAP leads in all attempted patients.
• LBB potential recorded in 61.5% of patients; selective LBBAP achieved in 85%.
• Post-implant mean QRS duration was 129.8 ± 13.1 ms; mean LV activation time was 75 ± 12 ms. No acute complications.

Conclusions:

• Navik 3D mapping system enables feasible 3D localization of the LBBA.
• The system shows promise in improving the accuracy of LBBA lead placement.
• 3D navigation may enhance the success rates and safety of LBBAP procedures.