Utility of a guiding catheter for conduction system pacing: An early multicenter experience

Abstract

Background: Conduction system pacing (CSP), either as His bundle pacing (HBP) or as left bundle branch area pacing (LBBAP), may be superior to right ventricular apical or septal pacing.

Objective: The study sought to present acute results for a new guiding catheter (Biotronik Selectra 3D) designed for CSP implantations of a retractable screw-in lead (Biotronik Solia S).

Methods: The primary endpoint of the prospective, international nonrandomized BIO|MASTER.Selectra 3D study was freedom from catheter-related serious adverse device effects (SADEs) within 1 week of lead implantation.

Results: Of 157 enrolled patients, CSP was achieved in 147 (93.6%) patients. No SADEs occurred within 7 days. LBBAP was achieved in 82 patients (45 as crossover from an HBP attempt) and HBP in 65 (44.2%) patients. In centers considering both HBP and LBBAP, the CSP implantation success approached 99%. Successful CSP implantations lasted on average ∼50 minutes (fluoroscopy ∼6 minutes). Most procedures (87.9%) needed only 1 catheter, even after switch from HBP to LBBAP. The catheter's handling was rated largely positive. In patients without bundle branch block, mean QRS duration increased from 106 ms (intrinsic) to 122 ms (CSP) (P = .001). In patients with bundle branch block, mean QRS duration decreased from 151 ms (intrinsic) to 137 ms (CSP) (P = .004).

Conclusion: The Selectra 3D catheter is a valuable tool for HBP and LBBAP implantations of the stylet-supported pacemaker leads. When implanters considered both HBP and LBBAP, the success rate was ∼99%. Flexibility to change between different approaches may be advisable in heterogeneous and challenging areas, such as CSP implantations.

Keywords: Cardiac pacing; Catheter handling characteristics; Conduction system pacing; Guiding catheter; His bundle; Left bundle branch area; Pacing lead implantation.

Graphical abstract

Figure 1

Selectra 3D catheters with 3 different curves: 40, 55, and 65 mm. The picture shows screw-in leads inserted in the catheters.

Figure 2

Implantation outcome vs day of the procedure from study beginning to study end. CSP = conduction system pacing; HBP = His bundle pacing; LBBAP = left bundle branch area pacing.

Figure 3

Handling characteristics of the Selectra 3D catheter (A, B) and Solia S lead (C) rated by implanters on a scale ranging from very good to very poor. In 19 patients in whom 2 or 3 Selectra 3D catheters were used, a single overall rating per patient was obtained. CSP = conduction system pacing; HBP = His bundle pacing; LBBAP = left bundle branch area pacing.

Figure 4

Comparison of implanters’ experience with the Selectra 3D catheter (n = 157) and the catheters for conduction system pacing (CSP) lead implantations they had used in the past (a variety of models).