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. 2023 Sep;46(9):1077-1084.
doi: 10.1111/pace.14804. Epub 2023 Aug 18.

Septal scar as a barrier to left bundle branch area pacing

Nadine Ali  1 , Ahran D Arnold  1 , Alejandra A Miyazawa  1 , Daniel Keene  1 , Nicholas S Peters  1 , Prapa Kanagaratnam  1 , Norman Qureshi  1 , Fu Siong Ng  1 , Nick W F Linton  1 , David C Lefroy  1 , Darrel P Francis  1 , Phang Boon Lim  1 , Peter Kellman  2 , Mark A Tanner  3 , Amal Muthumala  4 , Matthew Shun-Shin  1 , Zachary I Whinnett  1 , Graham D Cole  1
Affiliations

Septal scar as a barrier to left bundle branch area pacing

Nadine Ali et al. Pacing Clin Electrophysiol. 2023 Sep.

Abstract

Background: The use of left bundle branch area pacing (LBBAP) for bradycardia pacing and cardiac resynchronization is increasing, but implants are not always successful. We prospectively studied consecutive patients to determine whether septal scar contributes to implant failure.

Methods: Patients scheduled for bradycardia pacing or cardiac resynchronization therapy were prospectively enrolled. Recruited patients underwent preprocedural scar assessment by cardiac MRI with late gadolinium enhancement imaging. LBBAP was attempted using a lumenless lead (Medtronic 3830) via a transeptal approach.

Results: Thirty-five patients were recruited: 29 male, mean age 68 years, 10 ischemic, and 16 non-ischemic cardiomyopathy. Pacing indication was bradycardia in 26% and cardiac resynchronization in 74%. The lead was successfully deployed to the left ventricular septum in 30/35 (86%) and unsuccessful in the remaining 5/35 (14%). Septal late gadolinium enhancement was significantly less extensive in patients where left septal lead deployment was successful, compared those where it was unsuccessful (median 8%, IQR 2%-18% vs. median 54%, IQR 53%-57%, p < .001).

Conclusions: The presence of septal scar appears to make it more challenging to deploy a lead to the left ventricular septum via the transeptal route. Additional implant tools or alternative approaches may be required in patients with extensive septal scar.

Keywords: R wave peak time; biventricular pacing; cardiac resynchronization therapy; late gadolinium enhancement; left bundle branch area pacing.

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References

REFERENCES

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