Novel approach to left bundle branch area pacing lead implantation using a three-dimensional stylet.

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm Pub Date : 2024-11-15 DOI:10.1016/j.hrthm.2024.11.016

Bartosz Ludwik, Michał Labus, Tomasz Roleder, Paweł Moskal, Grzegorz Kiełbasa, Jerzy Śpikowski, Marek Jastrzębski

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引用次数: 0

Abstract

Background: Left bundle branch area pacing (LBBAP) requires implantation of the lead deep in the interventricular septum. We developed a novel implantation method, which does not require dedicated delivery catheters, but only a manually shaped three-dimensional (3D) stiff stylet.

Objective: The aim of the study was to characterize procedural outcomes of this technique when used as a routine approach for LBBAP.

Methods: A case-control study compared procedural outcomes of consecutive patients who underwent pacemaker implantation at two centers: one using only the 3D stylet-based LBBAP technique and the other using the conventional catheter-based LBBAP lead implantation.

Results: A total of 400 patients (age 75.3 ± 9.8 y., 48.3% female) were analyzed and 230 were matched and included in a 1:1 ratio in each arm of the implantation techniques. No differences were observed in the success rate (95.0% vs 94.8%), fluoroscopy time (9.9 min. vs 9.6 min.), paced QRS duration (151 ms vs. 148 ms) and sensitivity values (8.2 mV vs. 8.5 mV) between the 3D stylet-based and catheter-based techniques, respectively. Small differences were observed in V₆ R-wave peak time (73.2 ms vs 76.5 ms), capture threshold (0.63 V vs 0.83 V), higher percentage of confirmed LBB captures, (98.3% vs. 77.4%) and a numerically higher occurrence of delayed perforations (2/115 vs. 0/115) in 3D styled group.

Conclusion: LBBAP lead implantation with the use of manually shaped stiff 3D stylet is feasible and results in comparable outcomes to those achieved with leads implanted using dedicated pre-shaped delivery catheters.

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使用三维支架植入左束支区起搏导线的新方法。

背景：左束支区起搏（LBBAP）需要将导联植入室间隔深部。我们开发了一种新颖的植入方法，它不需要专用的输送导管，只需要一个人工塑造的三维（3D）硬质支架：本研究旨在描述该技术作为常规方法用于 LBBAP 时的手术效果：一项病例对照研究比较了在两个中心接受起搏器植入术的连续患者的手术结果：一个中心仅使用基于三维支架的LBBAP技术，另一个中心使用基于导管的传统LBBAP导联植入术：结果：共分析了 400 名患者（年龄为 75.3 ± 9.8 岁，48.3% 为女性），其中 230 名患者按 1:1 的比例被分别纳入两种植入技术。在成功率（95.0% vs 94.8%）、透视时间（9.9 分钟 vs 9.6 分钟）、起搏 QRS 持续时间（151 毫秒 vs 148 毫秒）和灵敏度值（8.2 毫伏 vs 8.5 毫伏）方面，三维支架技术和导管技术分别没有发现差异。在 V6 R 波峰值时间（73.2 ms vs 76.5 ms）、捕获阈值（0.63 V vs 0.83 V）、LBB 捕获确认百分比（98.3% vs 77.4%）和延迟穿孔发生率（2/115 vs 0/115）方面，观察到三维支架组存在微小差异：结论：使用人工塑形的硬质三维支架植入 LBBAP 导联是可行的，其结果与使用专用预塑形输送导管植入导联的结果相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.