Initial experience of left bundle branch pacing using the Abbott Agilis HisPro Catheter with stylet‐driven leads

Tay, Julian Cheong Kiat; Lim, Eric; Sim, Evan Yih Shan; Chua, Karen Sui Geok; Teo, Hooi Khee; Lim, Paul Chun Yih; Chong, Daniel; Ho, Kah Leng; Ching, Chi Keong; Tan, Boon Yew

doi:10.1111/pace.14505

Cited by 13 publications

(11 citation statements)

References 6 publications

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“…This is a single center retrospective study, with a relatively small number of operators, which could limit generalizability of this study. While sheath delivery systems from multiple manufacturers were used, the Abbott Agilis HisPro sheath was not included in this study; early experience with use of this sheath for LBBP has been described 19 . The relatively small sample size of the study may limit evaluation for small but clinically important differences in outcomes between the various delivery systems.…”

Section: Discussionmentioning

confidence: 99%

“…early experience with use of this sheath for LBBP has been described. 19 The relatively small sample size of the study may limit evaluation for small but clinically important differences in outcomes between the various delivery systems. Finally, there were differences between groups with regard to history of congestive heart failure, with a higher proportion of patients with heart failure in the lumenless group; this could potentially lead to confounding of results including procedure and fluoroscopy times, as a history of heart failure could lead to changes in anatomy making the procedures more difficult and lengthier.…”

Section: Limitationsmentioning

confidence: 99%

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Initial experience with stylet‐driven versus lumenless lead delivery systems for left bundle branch area pacing

Braunstein

Kagan

Olshan

et al. 2022

Cardiovasc electrophysiol

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Introduction: Left bundle branch area pacing (LBBP) has emerged as an alternative method for conduction system pacing. While initial experience with delivery systems for stylet-driven and lumenless lead implantation for LBBP has been described, data comparing outcomes of stylet-driven versus lumenless lead implantation for LBBP are limited. In this study, we compare success rates and outcomes of LBBP with stylet-driven versus lumenless lead delivery systems.Methods: Eighty-three consecutive patients (mean age 74.1 ± 11.2 years; 56 [68%] male) undergoing attempted LBBP at a single institution were identified. Cases were grouped by lead delivery systems used: stylet-driven (n = 53) or lumenless (n = 30).Baseline characteristics and procedural findings were recorded and compared between the cohorts. Intermediate term follow-up data on ventricular lead parameters were also compared.Results: Baseline characteristics were similar between groups. Successful LBBP was achieved in 77% of patients, with similar success rates between groups (76% in stylet-driven, 80% in lumenless, p = 0.79), and rates of adjudicated LBB capture and other paced QRS parameters were also similar. Compared with the lumenless group, the stylet-driven group had significantly shorter procedure times (90 ± 4 vs. 112 ± 31 min, p = 0.004) and fluoroscopy times (10 ± 5 vs. 15 ± 6 min, p = 0.003).Ventricular lead parameters at follow-up were similar, and rates of procedural complications and need for lead revision were low in both groups. Conclusion:Delivery systems for stylet-driven and for lumenless leads for LBBP have comparable acute success rates. Long-term follow-up of lead performance following use of the various delivery systems is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Initial experience with stylet‐driven versus lumenless lead delivery systems for left bundle branch area pacing

Braunstein

Kagan

Olshan

et al. 2022

Cardiovasc electrophysiol

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“…Thus, reshaping the secondary curve proximal to the second deflection and septal curve would extend the access beyond the tricuspid valve and enable the reaching of the RV septum perpendicularly. 10 In nine patients with left posterior fascicular pacing, several attempts to deploy the lead at the true left bundle branch trunk failed because the sheath and the lead would have an oblique rather than perpendicular orientation to the RV septum. A more perpendicular septal orientation could be achieved by further unreflecting and retracting the catheter, which positioned the sheath inferior to the previously attempted site toward the apex and left posterior fascicle.…”

Section: Discussionmentioning

confidence: 99%

“…The details have been previously described. 10 Briefly, the sheath was introduced into the RV and on the right side of the interventricular septum. The location for LBBAP was 1-1.5 cm distal to the His signal.…”

Section: Methodsmentioning

confidence: 99%

Initial Experience with Left Bundle Branch Area Pacing in Patients with Atrioventricular Block and Impaired LV Function

Kim

Choi

et al. 2023

Chonnam Med J

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Chronic right ventricular (RV) pacing can exacerbate heart failure in patients with a low left ventricular ejection fraction (LVEF). Left bundle branch area pacing (LBBAP) has emerged as a novel physiological pacing technique; however, information remains limited on its use among patients with a low EF. This study investigated the safety and short-term clinical outcomes of LBBAP among patients with impaired left ventricular (LV) function. This retrospective analysis of pacemakers at Chosun University Hospital, South Korea, included all patients with impaired LV function (EF<50%) who underwent pacemaker implantation for atrioventricular blockage from 2019-2022. Clinical characteristics, 12-lead electrocardiography findings, echocardiography findings, and laboratory parameters were evaluated. Composite outcomes were defined as all-cause mortality, cardiac death, and hospitalization due to heart failure during the 6-month follow-up. Altogether 57 patients (25 men; mean age, 77.4±10.8 y; LVEF, 41.5±3.8%) were divided into LBBAP (n=16), biventricular pacing (BVP; n=16), and conventional RV pacing (RVP; n=25) groups. In the LBBAP group, the mean paced QRS duration (pQRSd) was narrower (119.5±14.7 vs. 140.2±14.3 vs. 163.2±13.9; p<0.001) and cardiac troponin I level was elevated post-pacing (1.14±1.29 vs. 0.20±0.29 vs. 0.24±0.51, p=0.001). Lead parameters were stable. One patient was hospitalized, and four died (one patient each from heart failure admission, myocardial infarction, unexplained death, and pneumonia in RVP vs. one from intracerebral hemorrhage in BVP) during the follow-up period. In conclusion, LBBAP is feasible in patients with impaired LV function without acute or significant complications and provides a remarkably narrower pQRSd with a stable pacing threshold.

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“…All studies included in this meta-analysis performed LBBAP using lumenless pacing leads, with an average acute success rate of 91.3%. In one case series wherein LBBAP was performed in patients with HFmrEF using stylet driven leads, the success rate was 100% (n=4) 38 Although procedure-related complications of septal perforation, pneumothorax, pocket infection, pocket hematoma, and lead dislodgements occurred during the follow-up period, no major implantation-related complications were observed.…”

Section: Feasibility Of Lbbap In Hfmrefmentioning

confidence: 99%

Left bundle branch area pacing in mildly reduced heart failure: A systematic literature review and meta-analysis

Kim

Cho

et al. 2022

Preprint

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Background: Although the beneficial effects of cardiac resynchronization therapy (CRT) in heart failure (HF) are fully established in HF with left ventricular ejection fraction (LVEF) ≤ 35%, CRT strategy for HF with mildly reduced ejection fraction (HFmrEF) is controversial. Left bundle branch area pacing (LBBAP) is an emerging pacing modality and an alternative option to CRT, and the efficacy and safety are promising so far. The aim of this analysis was to perform a systematic review of the literature and meta‐analysis on impact of LBBAP strategy in HFmrEF, with LVEF between 35 % and 50%. Methods: PubMed, Embase, and Cochrane Library were searched for full-text articles on LBBAP from inception to July 17, 2022. The outcomes of interest were QRS duration, and LVEF at baseline and at follow-up in mid-range HF. Data were extracted and summarized. A random-effect model incorporating the potential heterogeneity was used to synthesize the results. Results: Out of 1065 articles, 8 met the inclusion criteria for 211 mid-range HF patients with an implant LBBAP across the 16 centers. The average implant success rate with lumenless pacing lead use was 91.3%, and 19 complications were reported among all 211 enrolled patients. During the average follow-up of 9.1 months, average LVEF were 39.8% at baseline and 50.5% at follow-up (MD: 10.90%, 95% CI: 6.56 - 15.23 P<0.01). Average QRS duration were 152.6ms at baseline and 119.3ms at follow-up (MD: -34.51ms, 95% CI: -60.00 to -9.02, P < 0.01). Conclusion: LBBAP could significantly reduce QRS duration and improve systolic function in patient with LVEF between 35 and 50%. Application of LBBAP as a CRT strategy for heart failure with mildly reduced ejection fraction may be a viable option.

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Initial experience of left bundle branch pacing using the Abbott Agilis HisPro Catheter with stylet‐driven leads

Cited by 13 publications

References 6 publications

Initial experience with stylet‐driven versus lumenless lead delivery systems for left bundle branch area pacing

Initial experience with stylet‐driven versus lumenless lead delivery systems for left bundle branch area pacing

Initial Experience with Left Bundle Branch Area Pacing in Patients with Atrioventricular Block and Impaired LV Function

Left bundle branch area pacing in mildly reduced heart failure: A systematic literature review and meta-analysis

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