Lead Integrity and Failure Evaluation in Left Bundle Branch Area Pacing (LIFE-LBBAP) Study.

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2024-11-20 DOI:10.1016/j.jacep.2024.09.020

Jan De Pooter, Alexander Breitenstein, Emine Özpak, Andreas Haeberlin, Daniel Hofer, Jean-Benoit Le Polain de Waroux, Aurélien Wauters, Tae-Hoon Kim, So-Ryoung Lee, Young Jun Park, Michael Gobitz, Grzegorz Kiełbasa, Dipen Zalavadia, Heli Tolppanen, David Žižek, Francesco Zanon, Lina Marcantoni, Shunmuga Sundaram Ponnusamy, Jarkko Karvonen, Oscar Cano, Marek Jastrzebski, Pugazhendhi Vijayaraman, Haran Burri

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引用次数: 0

Abstract

Background: Left bundle branch area pacing (LBBAP) has gained increased adoption globally with the use of both lumenless leads (LLLs) and stylet-driven leads (SDLs). As these leads have been developed for conventional endocardial pacing sites, concerns remain regarding the lead integrity with LBBAP.

Objectives: This study evaluates lead integrity of pacing leads used for LBBAP in a large, real-world cohort of patients with LBBAP.

Methods: Patients with successful LBBAP from 17 international centers were enrolled in this observational study. Data on overall lead integrity, fracture rates, and locations of fractures were collected.

Result: The study enrolled 8,255 patients with LBBAP (age 73 ± 13 years, 42% female, 68% LLLs, and 32% SDLs). Overall lead survival rate was 99.7% with median follow-up of 16.4 (Q1-Q3: 6.4-28.8) months. Lead fracture occurred in 12 of 8,255 (0.15%) patients. Lead fracture rates of LLLs occurred in 2 of 5,609 (0.04%) vs 10 of 2,646 (0.4%) patients for SDLs, during a follow-up of 19.5 (Q1-Q3: 9.7-33) and 10.3 (Q1-Q3: 2.9-19.7) months, respectively (P < 0.001). SDL fractures occurred at 13.9 (Q1-Q3: 6.1-17.7) months after implant, whereas 2 LLL fractures occurred at 21 and 31.4 months. SDL and LLL conductor fractures were observed in 7 of 17 and 2 of 17 centers, respectively. Confirmed fractures of the SDL lead originated within the interelectrode lead segment, whereas LLL fractures occurred proximal to the ring.

Conclusions: LBBAP lead performance of LLLs and SDLs is high at midterm follow-up. SDLs exhibit higher rates of fracture compared to LLLs. Hot spots for conductor fracture are the distal interelectrode segment in SDLs and the segment proximal to the ring electrode in LLLs.

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左束支区起搏中的导联完整性和故障评估 (LIFE-LBBAP) 研究。

背景：随着无腔导联（LLL）和支架驱动导联（SDL）的使用，左束支区起搏（LBBAP）已在全球范围内得到越来越多的应用。由于这些导联是为传统的心内膜起搏部位开发的，因此人们仍然担心 LBBAP 的导联完整性：本研究评估了用于 LBBAP 的起搏导联的导联完整性：这项观察性研究招募了来自 17 个国际中心的 LBBAP 成功患者。收集了有关总体导联完整性、骨折率和骨折位置的数据：该研究共招募了 8255 名 LBBAP 患者（年龄为 73 ± 13 岁，42% 为女性，68% 为 LLLs，32% 为 SDLs）。总铅存活率为 99.7%，中位随访时间为 16.4 个月（Q1-Q3：6.4-28.8 个月）。在 8255 例患者中，有 12 例（0.15%）发生了导联断裂。在 5609 位患者中，2 位（0.04%）发生了 LLL 导联骨折，而在 2646 位患者中，10 位（0.4%）发生了 SDL 导联骨折，随访时间分别为 19.5 个月（Q1-Q3：9.7-33 个月）和 10.3 个月（Q1-Q3：2.9-19.7 个月）（P < 0.001）。SDL骨折发生在植入后13.9个月（Q1-Q3：6.1-17.7），而2例LLL骨折分别发生在植入后21个月和31.4个月。17个中心中分别有7个和2个观察到SDL和LLL导体骨折。经证实，SDL 导联的骨折发生在电极间导联段，而 LLL 导联的骨折发生在环的近端：结论：在中期随访中，LLL 和 SDL 的 LBBAP 导联性能都很高。与 LLL 相比，SDL 的断裂率更高。导体断裂的热点是 SDL 的远端电极间区段和 LLL 的环形电极近端区段。

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

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.