Jenish P Shroff, Anugrah Nair, Deep Chandh Raja, Sreevilasam P Abhilash, Simon Fiorese, Jonathan P Ariyaratnam, Walter P Abhayaratna, Prashanthan Sanders, Pugazhendhi Vijayaraman, Rajeev K Pathak
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Tendril STS lead with a CPS Locator 3D catheter and SelectSecure 3830 lead with a C315HIS catheter were used in the SDL and LLL arms, respectively. LBBP was confirmed by standard criteria with measurements done on Labsystem Pro.</p><p><strong>Results: </strong>Patients in the LLL arm were significantly younger (71.9±11 versus 76.4±8.9 years; <i>P</i>=0.02); all other baseline characteristics were not significantly different. Acute success in LBBP was similar with SDL versus LLL (90% versus 92%; <i>P</i>=0.7). In patients with successful LBBP, screw attempts were not significantly different between the groups (2.3±1.7 in SDL versus 1.9±1.3 in LLL; <i>P</i>=0.2). Implant duration (11±9.6 versus 9.9±7.1 minutes; <i>P</i>=0.4), mean fluoroscopy dose (65.3±82.7 versus 53.5±50.5 mGy; <i>P</i>=0.5), and fluoroscopy time (7.8±4.8 versus 7.4±4 minutes; <i>P</i>=0.7) were also not different in the SDL versus the LLL arm, respectively. Incidence of lead failure (<i>P</i>=0.6), microdislodgement (<i>P</i>=1), and macrodislodgement (<i>P</i>=0.6) were not significantly different. Pacing threshold was comparable at implant and on follow-up at 1, 3, and 6 months.</p><p><strong>Conclusions: </strong>LBBP was feasible with both lead systems with similar success rate and low capture threshold. No significant difference was observed in procedure duration or fluoroscopy use. No major complications were recorded with either lead.</p><p><strong>Registration: </strong>URL: https://www.anzctr.org.au; Unique identifier: ACTRN12624000304538.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. 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Implant duration (11±9.6 versus 9.9±7.1 minutes; <i>P</i>=0.4), mean fluoroscopy dose (65.3±82.7 versus 53.5±50.5 mGy; <i>P</i>=0.5), and fluoroscopy time (7.8±4.8 versus 7.4±4 minutes; <i>P</i>=0.7) were also not different in the SDL versus the LLL arm, respectively. Incidence of lead failure (<i>P</i>=0.6), microdislodgement (<i>P</i>=1), and macrodislodgement (<i>P</i>=0.6) were not significantly different. Pacing threshold was comparable at implant and on follow-up at 1, 3, and 6 months.</p><p><strong>Conclusions: </strong>LBBP was feasible with both lead systems with similar success rate and low capture threshold. No significant difference was observed in procedure duration or fluoroscopy use. No major complications were recorded with either lead.</p><p><strong>Registration: </strong>URL: https://www.anzctr.org.au; Unique identifier: ACTRN12624000304538.</p>\",\"PeriodicalId\":10319,\"journal\":{\"name\":\"Circulation. 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引用次数: 0
摘要
背景：左束支起搏（LBBP）已成为一种安全有效的替代右心室起搏的方法。传统上，LBBP是用无管铅（LLL）进行的；然而，风格驱动型铅（SDL）的使用正在上升。我们的目的是评估SDL与LLL治疗LBBP的急性成功和手术结果。方法：连续100例慢速心律失常、心脏再同步化治疗指征或消融与起搏策略患者按1:1的比例随机分为SDL组和LLL组。在SDL臂和LLL臂分别使用Tendril STS导联与CPS Locator 3D导管和SelectSecure 3830导联与C315HIS导管。LBBP通过在Labsystem Pro上进行测量的标准标准确认。结果：LLL组患者明显更年轻(71.9±11岁vs 76.4±8.9岁；P = 0.02);其他基线特征均无显著差异。LBBP的急性成功率与SDL和LLL相似(90%对92%；P = 0.7)。在成功的LBBP患者中，两组间螺钉尝试次数无显著差异(SDL为2.3±1.7次，LLL为1.9±1.3次；P = 0.2)。种植持续时间（11±9.6 vs 9.9±7.1分钟）；P=0.4)，平均透视剂量（65.3±82.7 vs 53.5±50.5 mGy）；P=0.5)，透视时间(7.8±4.8 vs 7.4±4分钟；P=0.7)在SDL组和LLL组中也没有差异。铅管失效（P=0.6）、微位移（P=1）和大位移（P=0.6）的发生率无显著差异。起搏阈值在植入时和随访1、3、6个月时具有可比性。结论：两种导联系统均可实现LBBP，成功率相近，捕获阈值低。在手术时间或透视使用方面没有观察到显著差异。两种铅均未出现严重并发症。注册：网址：https://www.anzctr.org.au；唯一标识符：ACTRN12624000304538。
Comparison of Procedural Outcomes of Lumenless Fixed-Helix Versus Stylet-Driven Extendable-Helix Lead Systems in Left Bundle Branch Pacing: COMPARE LBBP.
Background: Left bundle branch pacing (LBBP) has emerged as a safe and effective alternative to right ventricular pacing. Traditionally, LBBP is performed with lumenless lead (LLL); however, the use of stylet-driven lead (SDL) is on rise. We aimed to assess acute success and procedural outcomes of SDL versus LLL for LBBP.
Methods: One hundred consecutive patients with bradyarrhythmia, indication of cardiac resynchronization therapy, or ablate and pace strategy were randomized in a 1:1 fashion to the SDL and LLL arms. Tendril STS lead with a CPS Locator 3D catheter and SelectSecure 3830 lead with a C315HIS catheter were used in the SDL and LLL arms, respectively. LBBP was confirmed by standard criteria with measurements done on Labsystem Pro.
Results: Patients in the LLL arm were significantly younger (71.9±11 versus 76.4±8.9 years; P=0.02); all other baseline characteristics were not significantly different. Acute success in LBBP was similar with SDL versus LLL (90% versus 92%; P=0.7). In patients with successful LBBP, screw attempts were not significantly different between the groups (2.3±1.7 in SDL versus 1.9±1.3 in LLL; P=0.2). Implant duration (11±9.6 versus 9.9±7.1 minutes; P=0.4), mean fluoroscopy dose (65.3±82.7 versus 53.5±50.5 mGy; P=0.5), and fluoroscopy time (7.8±4.8 versus 7.4±4 minutes; P=0.7) were also not different in the SDL versus the LLL arm, respectively. Incidence of lead failure (P=0.6), microdislodgement (P=1), and macrodislodgement (P=0.6) were not significantly different. Pacing threshold was comparable at implant and on follow-up at 1, 3, and 6 months.
Conclusions: LBBP was feasible with both lead systems with similar success rate and low capture threshold. No significant difference was observed in procedure duration or fluoroscopy use. No major complications were recorded with either lead.
期刊介绍：
Circulation: Arrhythmia and Electrophysiology is a journal dedicated to the study and application of clinical cardiac electrophysiology. It covers a wide range of topics including the diagnosis and treatment of cardiac arrhythmias, as well as research in this field. The journal accepts various types of studies, including observational research, clinical trials, epidemiological studies, and advancements in translational research.
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