Radiofrequency current-facilitated implantation of left bundle branch pacing lead for cardiac resynchronization therapy.

BACKGROUND

Fibrosis within the interventricular septum hinders the implantation of left bundle branch pacing (LBBP) lead, particularly in candidates for cardiac resynchronization therapy (CRT).

OBJECTIVE

This study aimed to report the acute and follow-up outcomes of pacing lead implantation using radiofrequency (RF) current delivered to the lead tip for septal electrosection in challenging LBBP cases.

METHODS

Data on lead deployment success, RF power and delivery time, complications, lead stability, proarrhythmia, current of injury, and pacing parameters were collected acutely and at the final follow-up.

RESULTS

A total of 37 RF-facilitated lead implantations in 36 patients (average age 71.6 ± 8.8 years), most of whom were CRT eligible (89%), were analyzed. On average, 2.1 ± 1.7 RF applications (resulting in 2.6 ± 2.2 seconds of RF) were used per implantation with a median power of 27 W. RF delivery was used in 85.7% of cases to achieve a current of injury drop that could not be obtained with manual lead rotation alone. Lead implantation was successful in all but 2 cases. The mean follow-up duration was 236 ± 165 days. Lead performance, including pacing parameters and lead stability, was good and did not seem to be affected by RF use (follow-up threshold 0.8 ± 0.3 V; sensitivity: 12.0 ± 5.6 mV). 1 patient experienced sustained ventricular tachycardia, and in all other cases, proarrhythmia was absent or self-limited. No other complications were noted.

CONCLUSION

RF-facilitated LBBP lead implantation is a feasible technique with potential cautious use as a bailout in selected cases, especially for failed CRT delivery.