Computerized tomography image correlation of His bundle/deep septal pacing location and outcomes: an analysis from the Canberra HIs bundle/deep septal Pacing Study (CHIPS)

Abstract

Background Localisation of the conduction system under fluoroscopy is not easy and the ideal location of the pacing leads in physiological pacing is still being debated. Objective The primary aim was to assess the lead locations using cardiac CT scan. Secondary aims were clinical outcomes including success and safety of the procedure and lead performance. Methods Of the 100 consecutive patients who received physiological pacing, 34 patients underwent follow-up cardiac CT scan. The four different types of pacing were identified as His bundle (HBP), para-Hisian, left bundle branch (LBBP), and deep septal pacing. Results Most patients had successful HBP via the right atrium (RA) (87.5%) as compared to the right ventricle (RV) (12.5%). Lower thresholds were observed when leads were placed within 2 mm of the junction of the membranous and muscular ventricular septum. Unlike HBP, LBBP was possible at a wide region of the septum and selective capture of individual fascicles was feasible. LBBP showed deeper penetration of leads into the septum, as compared to deep septal pacing (70% vs. 45%). Approximately, 80% of patients did not have an intra-ventricular portion of the membranous septum. Conclusions The anterior part of the atrio-ventricular (AV) septum at the junction between the membranous and muscular septum via RA appeared to be the best target to successfully pace His bundle. LBBP was possible at a wide region of the septum and selective capture of individual fascicle was feasible. Adequate depth of penetration of lead was very important to capture the left bundle.

Left bundle branch pacing vs ventricular septal pacing for cardiac resynchronization therapy

“… 23 The lead in DSP had much shallower penetration into the LV septal endocardium, which is consistent with previous reports using computed tomography imaging to compare lead depth. 24 As the left bundle runs very close to the LV endocardium, 25 , 26 an effort should be made to place the lead in the left-sided ventricular septum using electrical and imaging guidance (>10 mm).…”

A case report of far-field P-wave oversensing in left bundle branch area pacing

“…Subsequent computed tomography scan revealed a lead tip position 12 mm inferiorly from the insertion point of the septal leaflet of the tricuspid valve and in the posterior third of the interventricular septum, consistent with LBBAP and our suspicion of left posterior fascicular pacing on ECG ( Figure 3 A and 3 B). 3

Figure 3 Left anterior oblique cranial ( A ) and short-axis views ( B ) on cardiac computed tomography showing a lead tip position ( arrow ) 12 mm inferiorly from the insertion point of the septal leaflet of the tricuspid valve ( asterisk ) and in the posterior third of the interventricular septum.

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Heart Failure with Mildly Reduced Ejection Fraction—A Phenotype Waiting to Be Explored

“…The results showed that LBB pacing exhibited versatility in the septal regions and allowed for selective fascicle capture, with deeper lead penetration. The study emphasises the role of additional imaging in guiding lead depth for effective pacing [55].…”