Transthoracic echocardiography‐guided left bundle branch pacing without fluoroscopic guidance: A case report

Tan, Kunyue; Deng, Xiaoqi; Wang, Shuzhen; Liu, Chunxia; Zhao, Ruohan; Xiong, Feng

doi:10.1002/jcu.22830

Cited by 5 publications

(5 citation statements)

References 9 publications

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“…However, some experiences of pacemaker implantations under exclusive ultrasound guidance, without fluoroscopy, have been reported (9); this approach is beneficial for both patients and operators, in particular clinical settings, such as in our case. To our knowledge, this is the first report of pacemaker implantation in these conditions of extrinsic right atrial compression.…”

Section: Discussionmentioning

confidence: 76%

A challenging pacemaker implantation in the presence of a giant right coronary aneurysm compressing the right atrium

Maffè

Paffoni

Bergamasco

et al. 2021

Monaldi Arch Chest Dis

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Giant coronary artery aneurysm is an uncommon disease, treated with surgical intervention or percutaneous coil embolization. A thrombosed aneurysm can cause extrinsic compression on the cardiac chambers, with potential hemodynamic effects and may cause problems when we need to implant a cardiac device. We present a case of difficult pacemaker implantation in a patient with 3 syncopes, first-degree AV block and complete left bundle branch block on electrocardiogram. The patient presented a giant aneurysm of the right coronary artery (85 x 90 mm), thrombosed, with right atrial compression. The pacemaker implantation was hampered by the difficulty of passing the lead through the compressed right atrium; indeed, only with simultaneous echocardiographic and fluoroscopic guidance, was it possible to complete the procedure. This case demonstrates the utility of echocardiogram, in particular settings, in cardiac stimulation procedures.

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Section: Discussionmentioning

confidence: 76%

A challenging pacemaker implantation in the presence of a giant right coronary aneurysm compressing the right atrium

Maffè

Paffoni

Bergamasco

et al. 2021

Monaldi Arch Chest Dis

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“…3D mapping and EnSite Precision (Abbott) mapping system were helpful in achieving LBBP 53 in patients with LBBB. Using standard transthoracic echocardiography (TTE) without fluoroscopic guidance, LBBP can be achieved successfully which is especially useful in pregnant female 54 . Non‐invasive high‐resolution electrocardiographic imaging (ECGI) which generates whole‐heart epicardial maps under physiological conditions has proven useful in CSP implantation 55 and recent prototypes are now fully CMR‐compatible 56 …”

Section: Introductionmentioning

confidence: 99%

Cardiovascular imaging in conduction system pacing: What does the clinician need?

Yue

Yuan

Mao

et al. 2023

Pacing Clinical Electrophis

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Permanent pacemakers are used for symptomatic bradycardia and biventricular pacing (BVP)‐cardiac resynchronization therapy (BVP‐CRT) is established for heart failure (HF) patients traditionally. According to guidelines, patients’ selection for CRT is based on QRS duration (QRSd) and morphology by surface electrocardiogram (ECG). Cardiovascular imaging techniques evaluate cardiac structure and function as well as identify pathophysiological substrate changes including the presence of scar. Cardiovascular imaging helps by improving the selection of candidates, guiding left ventricular (LV) lead placement, and optimization devices during the follow‐up. Conduction system pacing (CSP) includes His bundle pacing (HBP) and left bundle branch pacing (LBBP) which is screwed into the interventricular septum. CSP maintains and restores ventricular synchrony in patients with native narrow QRSd and left bundle branch block (LBBB), respectively. LBBP is more feasible than HBP due to a wider target area. This review highlights the role of multimodality cardiovascular imaging including fluoroscopy, echocardiography, cardiac magnetic resonance (CMR), myocardial scintigraphy, and computed tomography (CT) in the pre‐procedure assessment for CSP, better selection for CSP candidates, the guidance of CSP lead implantation, and the optimization of devices programming after the procedure. We also compare the different characteristics of multimodality imaging and discuss their potential roles in future CSP implantation.

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“…However, although a case report has shown the feasibility of TTE-guided LBBP, drawing comprehensive and systematic conclusions from the single sample is not enough. 12 Therefore, the present study aims to compare the procedure and fluoroscopy time between TTE-guided and X-ray-guided LBBP, determining whether TTE-guided LBBP could reduce the procedure and fluoroscopy time, and evaluate its feasibility and safety.…”

mentioning

confidence: 99%

Comparison of clinical outcomes between transthoracic echocardiography‐ and X‐ray‐guided left bundle branch pacing for bradycardia: A randomized controlled trial

Yang,

Tao,

Fan

et al. 2024

Cardiovasc electrophysiol

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IntroductionLeft bundle branch pacing (LBBP) is a physiological pacing modality. However, the long procedure and fluoroscopy time of LBBP is still a problem. This study aims to compare the clinical outcomes between transthoracic echocardiography (TTE)‐ and X‐ray‐guided LBBP.MethodsThis is a single‐center, prospective, randomized controlled study. Consecutive patients who underwent LBBP in our team from June 2022 to November 2022 were enrolled. Procedure and fluoroscopy time, pacing parameters, electrophysiological and echocardiographic characteristics, as well as complications were recorded at implantation and during follow‐up.ResultsIn this study, 60 patients were enrolled and divided into two groups: 30 patients were allocated to the X‐ray group and the remaining 30 to the TTE group. There was no significant difference in the success rate between the two groups (86.7% vs. 76.7%, p = .317). The procedure time of TTE group was comparable to that of the X‐ray group (9.0 vs. 12.0 min, p = .063). However, the fluoroscopy time in the TTE group was significantly lower than that of the X‐ray group (2.5 vs. 5.0 min, p = .002). There were no statistically significant differences in pacing parameters, electrophysiological and echocardiographic characteristics, or complications between the two groups at implantation and during follow‐up.ConclusionTTE‐guided LBBP is a feasible and safe method. Compared with X‐ray, TTE showed a comparable success rate and procedure time, but it could significantly reduce the fluoroscopy time of LBBP.

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Transthoracic echocardiography‐guided left bundle branch pacing without fluoroscopic guidance: A case report

Abstract: This case study demonstrates the feasibility of pacing the left bundle branch and atrial septum under transthoracic echocardiography (TTE) without fluoroscopic guidance. This technique could be useful to guide pacemaker implantation in some patients, especially pregnant women.

Cited by 5 publications

References 9 publications

A challenging pacemaker implantation in the presence of a giant right coronary aneurysm compressing the right atrium

A challenging pacemaker implantation in the presence of a giant right coronary aneurysm compressing the right atrium

Cardiovascular imaging in conduction system pacing: What does the clinician need?

Comparison of clinical outcomes between transthoracic echocardiography‐ and X‐ray‐guided left bundle branch pacing for bradycardia: A randomized controlled trial

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