Septal scar as a barrier to left bundle branch area pacing

The use of left bundle branch area pacing (LBBAP) for bradycardia pacing and cardiac resynchronization is increasing, but implants are not always successful. We prospectively studied consecutive patients to determine whether septal scar contributes to implant failure. Patients scheduled for bradycar...

Full description

Saved in:
Bibliographic Details
Published in:Pacing and clinical electrophysiology 2023-09, Vol.46 (9), p.1077-1084
Main Authors: Ali, Nadine, Arnold, Ahran D, Miyazawa, Alejandra A, Keene, Daniel, Peters, Nicholas S, Kanagaratnam, Prapa, Qureshi, Norman, Ng, Fu Siong, Linton, Nick W F, Lefroy, David C, Francis, Darrel P, Lim, Phang Boon, Kellman, Peter, Tanner, Mark A, Muthumala, Amal, Shun-Shin, Matthew, Whinnett, Zachary I, Cole, Graham D
Format: Article
Language:English
Subjects:
Aged
Bradycardia
Cardiac arrhythmia
Cardiomyopathy
Cicatrix
Contrast Media
Gadolinium
Heart
Humans
Ischemia
Male
Septum
Transplants & implants
Ventricle
Ventricular Septum - diagnostic imaging
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The use of left bundle branch area pacing (LBBAP) for bradycardia pacing and cardiac resynchronization is increasing, but implants are not always successful. We prospectively studied consecutive patients to determine whether septal scar contributes to implant failure. Patients scheduled for bradycardia pacing or cardiac resynchronization therapy were prospectively enrolled. Recruited patients underwent preprocedural scar assessment by cardiac MRI with late gadolinium enhancement imaging. LBBAP was attempted using a lumenless lead (Medtronic 3830) via a transeptal approach. Thirty-five patients were recruited: 29 male, mean age 68 years, 10 ischemic, and 16 non-ischemic cardiomyopathy. Pacing indication was bradycardia in 26% and cardiac resynchronization in 74%. The lead was successfully deployed to the left ventricular septum in 30/35 (86%) and unsuccessful in the remaining 5/35 (14%). Septal late gadolinium enhancement was significantly less extensive in patients where left septal lead deployment was successful, compared those where it was unsuccessful (median 8%, IQR 2%-18% vs. median 54%, IQR 53%-57%, p 
ISSN:0147-8389
1540-8159
1540-8159
DOI:10.1111/pace.14804