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. 2024 Sep 23:11:1449859.
doi: 10.3389/fcvm.2024.1449859. eCollection 2024.

Predictors of success in left bundle branch area pacing with stylet-driven pacing leads: a multicenter investigation

Ga-In Yu  1 , Tae-Hoon Kim  2 , Jung-Myung Lee  3 , Daehoon Kim  2 , Hee Tae Yu  2 , Jae-Sun Uhm  2 , Boyoung Joung  2 , Hui-Nam Pak  2 , Moon-Hyoung Lee  2
Affiliations

Predictors of success in left bundle branch area pacing with stylet-driven pacing leads: a multicenter investigation

Ga-In Yu et al. Front Cardiovasc Med. .

Abstract

Purpose: Although left bundle branch area pacing (LBBAP) is an emerging conduction system pacing modality, it is unclear which parameters predict procedural success and how many implant attempts are acceptable. This study aimed to assess predictors of successful LBBAP, left bundle branch (LBB) capture, and factors associated with the number of LBBAP implant attempts.

Methods: This retrospective observational multicenter study was conducted in Korea. LBBAP was attempted in 119 patients; 89.3% of patients had bradyarrhythmia (atrioventricular block 82.4%), and 10.7% of patients had heart failure (cardiac resynchronization therapy) indication. Procedural success and electrophysiological and echocardiographic parameters were evaluated.

Results: The acute success rate of lead implantation in LBBAP was 95.8% (114 of 119 patients) and that of LBB capture was 82.4% (98 of 119 patients). Fewer implant attempts were associated with LBBAP success (three or fewer vs. over three times, p = 0.014) and LBB capture (three or fewer vs. over three times, p = 0.010). In the multivariate linear regression, the patients with intraventricular conduction delay (IVCD) required a greater number of attempts than those without IVCD [estimates = 2.33 (0.35-4.31), p = 0.02], and the larger the right atrial (RA) size, the more the attempts required for LBBAP lead implantation [estimates = 2.08 (1.20-2.97), p < 0.001].

Conclusion: An increase in the number of implant attempts was associated with LBBAP procedural failure and LBB capture failure. The electrocardiographic parameter IVCD and the echocardiographic parameter RA size may predict the procedural complexity and the number of lead implant attempts for LBBAP.

Keywords: conduction system pacing; interventricular conduction delay; left bundle branch area pacing; right atrial diameter; stylet-driven pacing leads.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Acute procedural outcomes of the LBBAP using SDL according to the number of attempts. (A) The greater the number of attempts at LBBAP using SDL, the more likely the procedure was to fail (B) There was a significant correlation between the procedural outcome and number of attempts. LBBAP, left bundle branch area pacing; LVSP, left ventricular septal pacing; LBBP, left bundle branch area pacing; SDL, stylet-driven pacing lead.
Figure 2
Figure 2
Complications of the left bundle branch area pacing using a stylet-driven pacing lead according to the number of attempts. As the number of lead implant attempts increases, the tendency for acute procedural complications increases.
Figure 3
Figure 3
Right atrial chamber size and number of attempts for the left bundle branch area pacing using a stylet-driven pacing lead. (A) A larger RA minor axis dimension and (B) larger RA major axis dimension were correlated with more procedure attempts. RA, right atrial.
See this image and copyright information in PMC

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