National Heart and Lung Institute, Imperial College London, London, UK.
National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, USA.
Pacing Clin Electrophysiol. 2023 Sep;46(9):1077-1084. doi: 10.1111/pace.14804. Epub 2023 Aug 18.
The use of left bundle branch area pacing (LBBAP) for bradycardia pacing and cardiac resynchronization is increasing, but implants are not always successful. We prospectively studied consecutive patients to determine whether septal scar contributes to implant failure.
Patients scheduled for bradycardia pacing or cardiac resynchronization therapy were prospectively enrolled. Recruited patients underwent preprocedural scar assessment by cardiac MRI with late gadolinium enhancement imaging. LBBAP was attempted using a lumenless lead (Medtronic 3830) via a transeptal approach.
Thirty-five patients were recruited: 29 male, mean age 68 years, 10 ischemic, and 16 non-ischemic cardiomyopathy. Pacing indication was bradycardia in 26% and cardiac resynchronization in 74%. The lead was successfully deployed to the left ventricular septum in 30/35 (86%) and unsuccessful in the remaining 5/35 (14%). Septal late gadolinium enhancement was significantly less extensive in patients where left septal lead deployment was successful, compared those where it was unsuccessful (median 8%, IQR 2%-18% vs. median 54%, IQR 53%-57%, p < .001).
The presence of septal scar appears to make it more challenging to deploy a lead to the left ventricular septum via the transeptal route. Additional implant tools or alternative approaches may be required in patients with extensive septal scar.
左束支区域起搏（LBBAP）在缓慢性起搏和心脏再同步治疗中的应用越来越多，但植入并不总是成功的。我们前瞻性研究了连续患者，以确定间隔瘢痕是否有助于植入失败。
前瞻性招募了计划进行缓慢性起搏或心脏再同步治疗的患者。入选的患者通过心脏 MRI 进行了术前瘢痕评估，包括延迟钆增强成像。使用无内腔导联（美敦力 3830）通过经房间隔途径尝试 LBBAP。
共招募了 35 例患者：29 例男性，平均年龄 68 岁，10 例缺血性，16 例非缺血性心肌病。起搏指征为缓慢性 26%，心脏再同步治疗 74%。35 例中有 30 例（86%）成功将导联放置到左室间隔，其余 5 例（14%）不成功。与植入不成功的患者相比，左室间隔导联成功植入的患者间隔晚期钆增强明显更不广泛（中位数 8%，IQR 2%-18% vs. 中位数 54%，IQR 53%-57%，p<.001）。
间隔瘢痕的存在似乎使通过经房间隔途径将导联放置到左室间隔更加困难。在有广泛间隔瘢痕的患者中，可能需要额外的植入工具或替代方法。
