Distance between the lead-implanted site and tricuspid valve annulus in patients with left bundle branch pacing: Effects on postoperative tricuspid regurgitation deterioration

Hu, Qingyun; You, Hongzhao; Chen, Keping; Dai, Yan; Lu, Wenzhao; Li, Yao; Cheng, Chendi; Zhou, Yuan; Wang, Jiaqi; Chen, Ruohan; Zhang, Shu

doi:10.1016/j.hrthm.2022.10.027

Cited by 28 publications

(19 citation statements)

References 22 publications

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“… 54 , 60 All these methods target sites which are further away from the His bundle region than the initially described target of 1.5–2 cm from the His bundle potential, suggesting that they correspond more to LFP than to LBBP. Placement of the LBBAP lead > 16 mm 61 or >19 mm 62 from the tricuspid annulus was associated with less tricuspid valve regurgitation than in a more proximal position.…”

Section: Left Bundle Branch Area Pacingmentioning

confidence: 87%

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EHRA clinical consensus statement on conduction system pacing implantation: endorsed by the Asia Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS), and Latin American Heart Rhythm Society (LAHRS)

et al. 2023

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Conduction system pacing (CSP) has emerged as a more physiological alternative to right ventricular pacing and is also being used in selected cases for cardiac resynchronization therapy. His bundle pacing was first introduced over two decades ago and its use has risen over the last five years with the advent of tools which have facilitated implantation. Left bundle branch area pacing is more recent but its adoption is growing fast due to a wider target area and excellent electrical parameters. Nevertheless, as with any intervention, proper technique is a prerequisite for safe and effective delivery of therapy. This document aims to standardize the procedure and to provide a framework for physicians who wish to start CSP implantation, or who wish to improve their technique.

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Section: Left Bundle Branch Area Pacingmentioning

confidence: 87%

“…Worsening of tricuspid regurgitation is observed in up to a third of patients 61 and is more frequent in patients with basal leads. 61 , 62 …”

Section: Peri- and Post-operative Complicationsmentioning

confidence: 99%

EHRA clinical consensus statement on conduction system pacing implantation: endorsed by the Asia Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS), and Latin American Heart Rhythm Society (LAHRS)

et al. 2023

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“…increases the risk of postoperative TR worsening. 10,11 Therefore, apical lead implantation may be preferred due to the increased risk of postoperative worsening of TR. Of note, in our case, the septal lead depth at the end of the procedure was lower than the average lead depth given in the literature (11 mm vs. 14 ± 23 mm, respectively).…”

Section: Discussionmentioning

confidence: 99%

Tricuspid regurgitation and infective endocarditis as a cause of lead dislodgement in left bundle branch area pacing

Ekinci

2023

Pacing Clinical Electrophis

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BackgroundAccording to the current literature, there is no difference between left bundle brunch area pacing (LBBAP) and right ventricular apical pacing in terms of lead dislodgement and capture threshold elevation. However, there are no large‐scale studies reporting the data about long‐term lead stability in patients with severe tricuspid regurgitation.Methods and ResultsWe present a case of lead dislodgement with possible infective endocarditis six months after implantation in a patient with severe tricuspid regurgitation who underwent LBBAP.ConclusionsWe concluded that severe preoperative tricuspid regurgitation may cause lead dislodgement, and infective endocarditis may be a facilitator or main reason of lead dislodgement in cases of LBBAP.

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“…However, it is not clear how far away from the tricuspid annulus or how close towards the apex the lead can be implanted without any deleterious effect on ventricular synchrony. 8 We here report a case where LBBA pacing implant was performed with the lead positioned >3 cm away from the tricuspid annulus due to the inability to fixate the lead deep into the septum at a position closer to the annulus. This subsequently led to worsening heart failure and decline in the patient's ejection fraction (EF), which was completely reversed by relocating the lead to a position closer to the annulus using a different technique.…”

Section: Introductionmentioning

confidence: 99%

“…Most LBBAP implantations were performed by aiming for an area 1–2 cm away from the distal His bundle signal towards the right ventricular (RV) apex. However, it is not clear how far away from the tricuspid annulus or how close towards the apex the lead can be implanted without any deleterious effect on ventricular synchrony 8 …”

Section: Introductionmentioning

confidence: 99%

Left bundle branch area pacing too far away from the tricuspid annulus may cause pacing induced cardiomyopathy

Meyers,

Liu

2023

Pacing Clinical Electrophis

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BackgroundPhysiologic pacing through left bundle branch area pacing (LBBAP) has recently been shown to be a very promising alternative for cardiac resynchronization therapy (CRT) and to avoid pacing induced cardiomyopathy. However, it is not clear whether the position of LABBP lead may affect the clinical outcomes.Case ReportWe here report a case of likely LBBAP induced worsening heart failure and cardiomyopathy reversed by re‐positioning of the pacing lead towards a more annular position. A 70‐year‐old male with a previous history of non‐ischemic dilated cardiomyopathy (ejection fraction 40%) who developed intermittent complete heart block and required permanent ventricular pacing. LBBAP was performed with the lead positioned to a position relatively far away from the tricuspid annulus (3.7 cm), due to difficulty in fixating the lead deep into the septum at a more annular position. One month post procedure, the patient's heart failure symptoms worsened, and his EF decreased to 31% despite good heart failure management. He underwent CRT upgrade with successful revision of the originally implanted LBBAP lead to a more annular position, using a deflectable delivery sheath. This resulted in further narrowing of the paced QRS duration from 135 to 106 ms. Two months post procedure, his heart failure symptoms improved by one functional class, and EF improved to 41% by echocardiogram.ConclusionsLBBAP may be harmful when the lead is placed too far away from the annulus and may cause paced induced cardiomyopathy.

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Distance between the lead-implanted site and tricuspid valve annulus in patients with left bundle branch pacing: Effects on postoperative tricuspid regurgitation deterioration

Cited by 28 publications

References 22 publications

EHRA clinical consensus statement on conduction system pacing implantation: endorsed by the Asia Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS), and Latin American Heart Rhythm Society (LAHRS)

EHRA clinical consensus statement on conduction system pacing implantation: endorsed by the Asia Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS), and Latin American Heart Rhythm Society (LAHRS)

Tricuspid regurgitation and infective endocarditis as a cause of lead dislodgement in left bundle branch area pacing

Left bundle branch area pacing too far away from the tricuspid annulus may cause pacing induced cardiomyopathy

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