Predictors of loss of capture in left bundle branch pacing: A multicenter experience

Tan, Esther; Lee, Jie-Ying; Boey, Elaine; Soh, Rodney; Seow, Swee‐Chong; Teo, Lisa JT.; Yeo, Colin; Tan, Vern Hsen; Kojodjojo, Pipin

doi:10.1016/j.hrthm.2022.06.003

Cited by 23 publications

(16 citation statements)

References 5 publications

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“…Last, the effects of CSP limitations including high pacing thresholds with HBP and loss of capture with LBBP on CRT are unknown. 18,31 Studies on long-term outcomes in these patients are required.…”

Section: Discussionmentioning

confidence: 99%

“…Fourth, sodium glucose co‐transporter‐2 (SGLT2)‐inhibitors were available at the time of implant to CSP patients due to its recent incorporation into guidelines. Last, the effects of CSP limitations including high pacing thresholds with HBP and loss of capture with LBBP on CRT are unknown 18,31 . Studies on long‐term outcomes in these patients are required.…”

Section: Discussionmentioning

confidence: 99%

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Conduction system versus biventricular pacing in heart failure with non‐left bundle branch block

Tan

Soh

Lee

et al. 2023

Cardiovasc electrophysiol

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Introduction The benefits of cardiac resynchronization therapy (CRT) with biventricular pacing (BiV) is significantly lower when applied to heart failure (HF) patients with non‐left bundle branch block (LBBB) conduction delay. We investigated clinical outcomes of conduction system pacing (CSP) for CRT in non‐LBBB HF. Methods Consecutive HF patients with non‐LBBB conduction delay undergoing CSP were propensity matched for age, sex, HF‐etiology, and atrial fibrillation (AF) in a 1:1 ratio to BiV from a prospective registry of CRT recipients. Echocardiographic response was defined as an increase in left ventricular ejection fraction (LVEF) by ≥10%. The primary outcome was the composite of HF‐hospitalizations or all‐cause mortality. Results A total of 96 patients were recruited (mean age 70 ± 11years, 22% female, 68% ischemic HF and 49% AF). Significant reductions in QRS duration and LV dimensions were seen only after CSP, while LVEF improved significantly in both groups (p < 0.05). Echocardiographic response occurred more frequently in CSP than BiV (51% vs. 21%, p < 0.01), with CSP independently associated with four‐fold increased odds (adjusted odds ratio 4.08, 95% confidence interval [CI] 1.34–12.41). The primary outcome occurred more frequently in BiV than CSP (69% vs. 27%, p < 0.001), with CSP independently associated with 58% risk reduction (adjusted hazard ratio [AHR] 0.42, 95% CI 0.21–0.84, p = 0.01), driven by reduced all‐cause mortality (AHR 0.22, 95% CI 0.07–0.68, p < 0.01), and a trend toward reduced HF‐hospitalization (AHR 0.51, 95% CI 0.21–1.21, p = 0.12). Conclusions CSP provided greater electrical synchrony, reverse remodeling, improved cardiac function and survival compared to BiV in non‐LBBB, and may be the preferred CRT strategy for non‐LBBB HF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Conduction system versus biventricular pacing in heart failure with non‐left bundle branch block

Tan

Soh

Lee

et al. 2023

Cardiovasc electrophysiol

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“…However, SDLs have been shown to be associated with higher incidence of LOCC during follow-up. Tan and colleagues 25 showed 12% (n = 22) incidence of LOCC among 191 successfully implanted patients during mean follow-up of 230 ± 144 days. LOCC was more frequently observed in patients who received SDLs as compared with LLLs.…”

Section: Follow-upmentioning

confidence: 98%

My preferred approach to left bundle branch pacing: Lumenless leads

Ponnusamy¹,

Vijayaraman²

2023

Heart Rhythm O2

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“…If entanglement is suspected, counter-clockwise rotation and slight traction on the SDL while maintaining tension on the inner lead coil usually untangle the lead. Another concern with SDLs is a possibly higher rate of loss of LBB capture than with lumenless leads, 96 which may have been due to the learning curve and which needs to be further evaluated.…”

Section: Considerations With Stylet-driven Pacing Leadsmentioning

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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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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Predictors of loss of capture in left bundle branch pacing: A multicenter experience

Cited by 23 publications

References 5 publications

Conduction system versus biventricular pacing in heart failure with non‐left bundle branch block

Conduction system versus biventricular pacing in heart failure with non‐left bundle branch block

My preferred approach to left bundle branch pacing: Lumenless leads

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)

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