Clinical Outcomes and Electrophysiological Characteristics of Partial Perforation After Left Bundle Branch Area Pacing.

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2025-03-18 DOI:10.1016/j.jacep.2025.01.016

Hiroyuki Kato, Satoshi Yanagisawa, Yuuki Shimizu, Ryusuke Ota, Taku Sakurai, Kazumasa Suga, Hisashi Murakami, Kenji Kada, Naoya Tsuboi, Yasuya Inden, Toyoaki Murohara

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引用次数: 0

Abstract

Background: Septal perforation, defined as partial or complete protrusion of a lead helix, is a potential complication of left bundle branch area pacing, theoretically increasing risks of pacing failure and thromboembolism. However, no studies have examined the long-term prognosis of patients with partial perforations (PPs).

Objectives: This study aimed to elucidate the incidence, outcomes, and electrophysiological characteristics of PP in clinical and experimental swine studies.

Methods: Patients requiring pacing who underwent successful left bundle branch area pacing were retrospectively included. PP was identified using postoperative echocardiography. Clinical outcomes, including all-cause mortality, thromboembolism, and lead-related complications, were compared between the PP and non-PP groups. Waveforms from the nonfiltered unipolar electrogram (NF-EGM) recorded at the lead tip were evaluated to identify morphology specific to PP.

Results: Of the 95 patients, PP was confirmed in 25 (26.3%), occurring only in patients with left bundle branch capture, with an incidence rate of 41.7%. Event-free survival rates were comparable between the PP and non-PP groups at a median follow-up of 24 months (log rank, P = 0.298). No thromboembolisms or lead-related complications occurred in the PP group. The type-QS and type-R morphologies of NF-EGM reliably identified and excluded PP, respectively, as validated in swine heart experiments.

Conclusions: This study found that PP is not associated with an increased risk of adverse clinical outcomes. Deep septal lead deployment utilizing the NF-EGM morphology would be useful in recognizing and avoiding PP intraoperatively.

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背景：室间隔穿孔（定义为导联螺旋部分或完全突出）是左束支区起搏的潜在并发症，理论上会增加起搏失败和血栓栓塞的风险。然而，目前还没有研究对部分穿孔（PPs）患者的长期预后进行调查：本研究旨在阐明临床和实验猪研究中 PP 的发生率、预后和电生理特征：方法：回顾性纳入需要起搏并成功接受左束支区起搏的患者。通过术后超声心动图确定 PP。比较了PP组和非PP组的临床结果，包括全因死亡率、血栓栓塞和导联相关并发症。对导联尖端记录的非滤波单极电图（NF-EGM）波形进行了评估，以确定PP的特异形态：结果：在 95 名患者中，25 人（26.3%）确诊为 PP，仅发生在左束支俘获患者中，发生率为 41.7%。中位随访 24 个月后，PP 组和非 PP 组的无事件生存率相当（对数秩，P = 0.298）。PP组未发生血栓栓塞或导联相关并发症。经猪心脏实验验证，NF-EGM的QS型和R型形态可分别可靠地识别和排除PP：本研究发现，PP 与不良临床结果风险的增加无关。结论：该研究发现 PP 与不良临床结果的风险增加无关。利用 NF-EGM 形态学进行房间隔深导联部署有助于在术中识别和避免 PP。

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.