Background: High burden of right ventricular (RV) pacing after pacemaker (PM) implantation can lead to pacemaker-induced cardiomyopathy (PMiCMP). Left bundle branch area pacing (LBBAP) offers a more physiological alternative and is endorsed by current guidelines. However, data on its feasibility, safety, and short-term outcomes in this population remains limited.
Our small cohort consisted of 34 (75.6 %) male patients with a median age of 77 (73, 84) years and with a median LVEF of 30 (24, 34), who presented with a mean NYHA Class of 2.9
0.5 (Table 1).
A stylet-driven pacemaker lead (Biotronik Solia S60) was implanted for LBBAP using a 3-dimensional delivery catheter (Biotronik Selectra 3D) in every procedure. All procedures were performed under deep sedation and under continuous 12-lead ECG monitoring to ensure LBBAP. We report on the first LBBAP upgrade procedures performed in our center and by our operators.
The 45 upgraded devices consisted of 7 single-chamber (2 single-chamber ICDs and 5 single-chamber PMs) and 38 dual-chamber devices (8 dual-chamber ICDs and 30 dual-chamber PMs). There were no system changes from ICD to pacemaker or vice versa (upgrade or downgrade). All patients received a new LBBAP electrode as part of the system upgrade.
Of all upgrade procedures, 44 (98%) were successfully performed with a low periprocedural complication rate of 2%. One complication occurred—a pneumothorax resulting from an unsuccessful subclavian vein puncture due to total venous occlusion. The patient was successfully treated with a chest tube. As the upgrade via the left subclavian vein was not feasible, a new dual-chamber system with LBBAP was implanted from the contralateral side 9 days later.
The median procedure time was 49 (Q1=44, Q3=47) minutes, fluoroscopy time was
7.1 (Q1=5.3, Q3=20.9) minutes and median dose area product was 540 (Q1=287, Q3=1129) cGy·cm2, all comparable to conventional biventricular CRT upgrades, as described in the literature. A significant QRS width reduction of 34% (from 186 ms to 122 ms) was achieved after the upgrade procedure due to LBBAP.
Three-month follow-up data was available of 66% of patients. It showed an increase of the median LVEF (from 30 to 40%).
Conclusions: Upgrade to LBBAP in patients with PMiCMP was feasible and safe, with a high success rate, low periprocedural complication rate, and significant QRS narrowing with improvement of LVEF after 3-months.
Table 1:
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Baseline characteristics
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Number of patients
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45
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Male gender
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34 (75.6%)
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Age (y)
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77 (73, 84)
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Dual chamber devices (PM, ICD)
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38 (30, 8)
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Single chamber devices (PM, ICD)
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7 (5, 2)
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Baseline ntproBNP (pg/ml)
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2301 (1192, 3242)
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Baseline QRS width (ms)
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186+/-22
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NYHA class
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2.9+/-0.5
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LVEF(%)
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30 (24, 34)
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Procedural data
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Procedure time (min)
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49 (44, 47)
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Fluoroscopy time (min)
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7.1 (5.3, 20.9)
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Area dose product (cGy·cm2)
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540 (287, 1129)
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Categorical data are summarized as n (%).Continuous data are summarized as medians (1. and 3. quartiles) or means+/-SD.
