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66 Left bundle branch area pacing in a non-electrophysiology centre
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66 Left bundle branch area pacing in a non-electrophysiology centre
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Journal Article
66 Left bundle branch area pacing in a non-electrophysiology centre
2025
Overview
BackgroundWhen it comes to device therapy, LV lead placement in heart failure patients with left ventricular dyssynchrony and broad QRS complex is the gold standard of care. Left bundle branch area (LBBA) pacing is a potentially evolving technique that may replace LV lead placement for cardiac dyssynchrony, requiring less technical skills than HIS-bundle pacing. With this in mind, we have established a program for LBBA pacing in University Hospital Limerick, a non-electrophysiology centre.MethodsThe implanting cardiology team attended a one-day hands on course, run by Biotronik, in London, to upskill in implantation technique for successful placement of LBBA leads.ResultsTo date, 14 patients have undergone LBBA lead placement. Indications include: pacing requirement of at least 20% with normal/mildly impaired LV function and a broad QRS complex; LV lead displacement with failure to reposition; and failure to place LV lead for CRT implantation. Successful LBBA lead placement during procedure is measured using the Left Ventricular Activation Time (LVAT) with a target of <80ms, the R-wave Morphology in Lead V1 (RWMP) targeted at >30ms, and visualization of R’ during lead implantation. Post procedure success is measured by assessing QRS duration via 12-lead ECG, targeted at <120ms. 12 of the 14 implantations were deemed complete success, with LVAT <80ms, RWMP >30ms, R’ visualization, and narrow QRS complexes on 12-lead ECG following implantation. 1 patient had partial success, with only R’ visualized and a narrow QRS post implantation. 1 patient had suboptimal lead position. There were no complications from procedure, notably pneumothorax, haematoma formation, infection, or lead dislodgement.ConclusionOur initial experience with LBBA pacing in a non-electrophysiology centre has shown that this new technique is not only feasible, but can be performed with a very high success rate. LBBA pacing provides a practical functional alternative to LV lead placement.
Publisher
BMJ Publishing Group LTD
Subject
