Delivery System Support Prevents Endocardial Entanglement and Delamination During Left Bundle Branch Area Pacing
Yuichiro Miyazaki1, Hiroshi Nakajima2, Mark Rimmer1
1Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles (UCLA) (Y.M., M.R., P.H., J.H.H., D.H.D., K.S., S.M.).
Circulation. Arrhythmia and Electrophysiology
|April 9, 2026
Summary
Delivery system support prevents endocardial entanglement and delamination during left bundle branch area pacing lead implantation in human hearts. This ensures effective screw-in lead penetration into the ventricular septum.
Area of Science:
- Cardiology
- Medical Devices
- Cardiac Electrophysiology
Background:
- Mechanisms of endocardial entanglement and delamination during left bundle branch area pacing are not fully understood in human hearts.
- Potential solutions for these issues require further investigation.
Purpose of the Study:
- To investigate the mechanisms of endocardial entanglement and delamination during lumenless screw-in lead implantation in the human ventricular septum.
- To evaluate the effectiveness of delivery system support in preventing these complications.
Main Methods:
- Active fixation of lumenless screw-in leads into the right ventricular septum of donor human hearts was performed with or without delivery system support.
- Macroscopic and microscopic analyses were used to evaluate endocardial entanglement, delamination, and lead penetration.
Main Results:
- A higher incidence of endocardial entanglement and helix-only penetration occurred in the group without support (70%) compared to the group with support (0%).
- Unscrewing entangled leads revealed extensive endocardial delamination entwined around the helix, with significantly larger delamination areas in the entanglement group.
- Histological analysis confirmed extensive endocardial delamination with minimal myocardial injury in entangled regions, while non-entangled regions showed localized delamination and deep intramural penetration.
Conclusions:
- Endocardial entanglement and delamination were confirmed in donor human hearts.
- Adequate delivery system support, including coaxiality and counterforce, is crucial for preventing endocardial entanglement.
- Effective delivery system support facilitates successful penetration of lumenless screw-in leads into the human ventricular septum.
More Related Videos
Related Concept Videos
01:29Cardiomyopathy V: Interprofessional Care
679
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
679
01:24Cardiac Catheterization III: Left Heart Catheterization
1.2K
Left heart catheterization is an invasive diagnostic procedure used to evaluate the function and structure of the left side of the heart. It is generally performed to diagnose and treat cardiovascular conditions such as valve abnormalities, coronary artery disease, and congenital heart defects.Diagnostic and therapeutic purposesLeft heart catheterization serves various diagnostic and therapeutic purposes, including:Assessing coronary artery bypass grafts.Evaluating coronary artery disease in...
1.2K
01:26Cardiac Catheterization IV: Nursing Management
1.2K
Nursing responsibilities before cardiac catheterization include:Assess for allergies and establish baseline health status.Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory...
1.2K
01:30Cardiomyopathy II: Dilated Cardiomyopathy
786
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
786
01:21Cardiac Catheterization II: Right Heart Catheterization
1.9K
Right Heart Catheterization: An OverviewRight heart catheterization is an invasive diagnostic procedure that measures right-sided cardiac and pulmonary artery pressures, calculates cardiac output, and identifies intracardiac shunts. It provides detailed hemodynamic data essential for diagnosing and managing various cardiovascular conditions, such as pulmonary hypertension.Access SitesCommon access sites for right heart catheterization include the internal jugular vein in the neck region, the...
1.9K
01:28Cardiac Catheterization I: Pre-Procedure Overview
2.8K
Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...
2.8K