Simplifying Physiological Left Bundle Branch Area Pacing Using a New Nine-Partition Method

• Published in: Canadian journal of cardiology 2021-02, Vol.37 (2), p.329-338
• Main Authors: Zhang, Junmeng, Wang, Zefeng, Zu, Linna, Cheng, Liting, Su, Ruijuan, Wang, Xinlu, Liang, Zhuo, Chen, Jieruo, Hang, Fei, Du, Jie, Huang, Weijian, Wu, Yongquan
• Format: Article
• Language: English
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2020.05.011

Left bundle branch area pacing (LBBaP) is accepted as a physiological form of pacing; however, it is complex and usually requires an expensive electrophysiological recording system. A simplified approach (“9-partition method”) was explored to perform LBBaP. In this method, a right anterior oblique 30° fluoroscopic image of the ventricle was divided into 9 sections (“3 × 3” partitions). From May 2018 to February 2019, we enrolled 51 consecutive patients who underwent pacemaker implantation. The patients were nonrandomly allocated to either the conventional LBBaP (c-LBBaP) group or simplified LBBaP (s-LBBaP) group. The mean age was 68.53 ± 11.90 years, and 32 (62.7%) patients were male. The overall success rate was 90.2% (46/51). Compared with the c-LBBaP group, the s-LBBaP group had a significantly lower total procedure duration (91.57 ± 19.51 minutes vs 70.68 ± 13.26 minutes; P < 0.001) and fluoroscopy duration (16.52 ± 5.34 minutes vs 10.54 ± 3.13 minutes; P < 0.001). The time from the 3830 lead and sheath passage through the tricuspid valve to an acceptable initial fixation site (4.69 ± 1.61 minutes vs 2.75 ± 1.04 minutes; P < 0.001) and the time to the left bundle branch lead being implanted successfully (11.78 ± 3.00 minutes vs 7.67 ± 2.45 minutes; P < 0.001) for the c-LBBaP vs s-LBBaP groups, respectively, were significantly different. After 3 months, there were no significant differences in the capture threshold, R wave amplitude, impedance, or QRS duration between the groups. Compared with the c-LBBaP approach, our simplified 9-partition method was faster and did not require an expensive electrophysiological recording system. La stimulation de la branche gauche (SBG) est une technique de stimulation physiologique reconnue; elle est toutefois complexe et exige le recours à un dispositif d’enregistrement physiologique coûteux. Nous avons exploré une approche simplifiée (appelée « méthode à 9 partitions ») permettant de stimuler la branche gauche. Cette méthode consiste à diviser en 9 sections (3 partitions sur 3 partitions) une image fluoroscopique prise en incidence oblique antérieure droite à 30°. De mai 2018 à février 2019, nous avons recruté 51 patients consécutifs ayant reçu un stimulateur cardiaque. Les patients ont été répartis non aléatoirement au groupe soumis à une SBG classique (SBGc) ou au groupe soumis à une SBG simplifiée (SBGs). Les sujets avaient en moyenne 68,53 ± 11,90 ans, et 32 (62,7 %) d’entre eux étaient des hommes. Le taux de ré