Heart Center, Ghent University Hospital, Ghent, Belgium.
J Cardiovasc Electrophysiol. 2021 Feb;32(2):439-448. doi: 10.1111/jce.14851. Epub 2021 Jan 4.
Left bundle branch area pacing (LBBAP) aims to achieve physiological pacing by capturing the conduction system in the area of the left bundle branch. LBBAP has exclusively been performed using lumen-less pacing leads (LLLs) with fixed helix design. This study explores the feasibility, safety, and pacing characteristics of LBBAP using stylet-driven leads (SDLs) with an extendable helix design.
Patients, in which LBBAP was attempted for bradycardia or heart failure pacing indications, were prospectively enrolled at the Ghent University Hospital. LBBAP was attempted with two different systems: 1/LLL with fixed helix (SelectSecure 3830, Medtronic Inc.) delivered through a preshaped sheath (C315His Medtronic Inc.) and 2/SDL with extendable helix (Solia S60, Biotronik, SE & CO) delivered through a new delivery sheath (Selectra 3D, Biotronik).
The study enrolled 50 patients (mean age: 70 ± 14 years, 44% females). LBBAP with SDL was successful in 20/23 (87%) patients compared with 24/27 (89%) of patients in the LLL group (p = 0.834). Screw attempts, screw implant depth, procedural, and fluoroscopy times were comparable among both groups. Acute LBBAP thresholds were low and comparable between SDL and LLL (0.5 ± 0.15 V vs. 0.4 ± 0.17 V, p = 0.251). Pacing thresholds remained low at 3 ± 2.1 months of follow up in both groups and no lead revisions were necessary. Postprocedural echocardiography revealed a septal coronary artery fistula in one patient with SDLLBBAP.
LBBAP using stylet-driven pacing leads is feasible and yields comparable implant success to LBBAP with LLLs. LBBAP thresholds are low and comparable with both types of leads.
左束支区域起搏（LBBAP）旨在通过捕获左束支区域的传导系统来实现生理起搏。LBBAP 仅使用具有固定螺旋设计的无腔起搏导线（LLL）进行。本研究探讨了使用具有可扩展螺旋设计的导丝驱动导线（SDL）进行 LBBAP 的可行性、安全性和起搏特性。
前瞻性招募因心动过缓或心力衰竭起搏指征而尝试 LBBAP 的患者在根特大学医院。尝试使用两种不同的系统进行 LBBAP：1/LLL 采用固定螺旋（美敦力公司的 SelectSecure 3830），通过预成型鞘管（美敦力公司的 C315His）输送和 2/SDL 采用可扩展螺旋（百多力公司的 Solia S60），通过新的输送鞘管（百多力公司的 Selectra 3D）输送。
该研究共纳入 50 名患者（平均年龄：70±14 岁，44%为女性）。与 LLL 组的 24/27 例（89%）相比，SDL 组的 20/23 例（87%）患者 LBBAP 成功（p=0.834）。两组的螺钉尝试、螺钉植入深度、程序和透视时间均相似。急性 LBBAP 阈值较低，且 SDL 和 LLL 之间无差异（0.5±0.15 V 与 0.4±0.17 V，p=0.251）。两组在 3±2.1 个月的随访中起搏阈值均较低，且无需进行导线修订。术后超声心动图显示在一例使用 SDLLBBAP 的患者中有间隔冠状动脉瘘。
使用导丝驱动起搏导线进行 LBBAP 是可行的，与使用 LLL 进行 LBBAP 相比，植入成功率相当。LBBAP 阈值较低，与两种类型的导线相似。
