Vijayaraman Pugazhendhi, Hughes Grace, Manganiello Marilee, Leri Gabriella, Laver Alexandra, Sacco Kaitlyn, Mroczka Kaitlyn, Schmidt Elliot, Mascarenhas Vernon H
Geisinger Heart Institute, Wilkes Barre, Pennsylvania.
Geisinger Heart Institute, Wilkes Barre, Pennsylvania.
Heart Rhythm. 2025 Sep;22(9):e746-e753. doi: 10.1016/j.hrthm.2024.12.039. Epub 2024 Dec 31.
Left bundle branch (LBB) pacing (LBBP) has gained rapid adoption. Evidence for direct LBB capture has varied from 30%-95% depending on the criteria.
The purpose of this study was to assess the feasibility and efficacy of intraprocedural transthoracic echocardiographic guidance to achieve LBB capture.
This was a prospective, nonrandomized, case-control study (ClinicalTrials.gov Identifier: NCT05646251). The pectoral region including echocardiographic windows were sterile-draped using Ioban. The lead was placed in the right ventricular septum and sheath orientation adjusted under echocardiography. The lead was advanced under echocardiographic visualization until the tip reached the left ventricular subendocardium. LBB capture was strictly defined: transition from nonselective to selective/left ventricular septal capture; LBB potential with injury current; and Delta (HBP-LBBP) VRWPT ≥10.
Thirty patients underwent echocardiography-guided left bundle branch pacing (EC-LBBP) and compared with 30 patients (standard approach): mean age 74.4 ± 10 years; female 45%; hypertension 92%; cardiomyopathy 43%; atrioventricular block/atrioventricular nodal ablation 75%. Total procedural and fluoroscopy durations were similar. Left bundle branch area pacing (LBBAP or left ventricular septal pacing) was successful in all patients in both groups. EC-LBBP was 97% successful in achieving LBB capture vs 70% (P = .02) with LBB potentials (LB-V 23 ± 6 ms) in 95% vs 77% (22 ± 6 ms). Morphology transition confirming LBB capture was seen in 87% vs 67% (P = .02). Lead tip was visualized at the left ventricular subendocardium in 100% of patients in EC-LBBP.
EC-LBBP was 97% successful in achieving LBB capture using strict criteria. LBBP lead was subendocardial in all patients. EC-LBBP is practical, feasible, safe, and highly effective in achieving LBB capture.
左束支起搏（LBBP）已迅速得到应用。根据标准不同，直接左束支夺获的证据在30%至95%之间变化。
本研究旨在评估术中经胸超声心动图引导实现左束支夺获的可行性和有效性。
这是一项前瞻性、非随机、病例对照研究（ClinicalTrials.gov标识符：NCT05646251）。使用Ioban对包括超声心动图窗口在内的胸部区域进行无菌铺巾。将导线置于右心室间隔，并在超声心动图引导下调整鞘管方向。在超声心动图可视化下推进导线，直到尖端到达左心室心内膜下。严格定义左束支夺获：从非选择性到选择性/左心室间隔夺获的转变；伴有损伤电流的左束支电位；以及Delta（HBP-LBBP）VRWPT≥10。
30例患者接受了超声心动图引导的左束支起搏（EC-LBBP），并与30例患者（标准方法）进行比较：平均年龄74.4±10岁；女性45%；高血压92%；心肌病43%；房室传导阻滞/房室结消融75%。总手术时间和透视时间相似。两组所有患者的左束支区域起搏（LBBAP或左心室间隔起搏）均成功。EC-LBBP实现左束支夺获的成功率为97%，而使用左束支电位时为70%（P = 0.02），95%的患者出现左束支电位（LB-V 23±6毫秒），而77%的患者（22±6毫秒）出现。确认左束支夺获的形态学转变在87%的患者中可见，而在67%的患者中可见（P = 0.02）。在EC-LBBP组中，100%的患者在左心室心内膜下可见导线尖端。
使用严格标准，EC-LBBP实现左束支夺获的成功率为97%。所有患者的LBBP导线均位于心内膜下。EC-LBBP在实现左束支夺获方面切实可行、安全且高效。
