Heart rhythm · 2026
Implantation of standard defibrillator leads in the left bundle branch area: Experience from an international cohort.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Imnadze Guram, Mandurino Cosimo, Briski Ana, Pandurangi Ulhas, Ghosh Anindya, Ponnusamy Shunmuga Sundaram, Notarangelo Francesca, Crocamo Antonio, Berenjkoub Ehssan, Vezi Brian, Bode Kerstin, Meyer Christian, Sommer Philipp, Cano Óscar, Vijayaraman Pugazhendhi, Burri Haran
Аннотация
BACKGROUND: Left bundle branch area defibrillation (LBBAD) therapy is currently an off-label procedure. Nevertheless, it is a promising technique that reduces the number of leads in implantable cardioverter-defibrillator patients who require conduction system pacing.
OBJECTIVE: This study aimed to collect real-world data on LBBAD implantation and follow-up.
METHODS: Retrospective periprocedural and follow-up data on electrocardiographic and electrical parameters, transthoracic echocardiography data, and clinical outcome were assembled from 12 international centers.
RESULTS: In total, 163 patients (age 67 ± 12 years; 137 males) were included. Implantation success rate was 88%. Defibrillation testing was performed in 85 patients and was effective in all cases. Paced unipolar QRS duration was 125 ms (119-135) with a V6 R-wave peak time of 76 ms (70-85) and a V6-V1 interpeak interval of 44 ms (45-54). Capture threshold was 0.8 V/0.4 ms (0.5-1.1), sensing amplitude was 9.0 mV (6.2-12), and pacing and high-voltage impedances were 580 Ω (493-650) and 66 Ω (60-75). Electrical parameters remained favorable over a follow-up of 8 months (3-13). Left ventricular ejection fraction improved from 30% (26%-35%) to 36% (31%-46%) at the last follow-up (P < .001). A total of 13 appropriate and effective shocks were documented, affecting 8 patients (4.9%). No ineffective shocks were reported. 2 LBBAD leads were explanted more than 1 year after implantation without any complication. No deaths were related to LBBAD.
CONCLUSION: LBBAD with standard stylet-driven lead is safe and feasible, with stable electrical, electrocardiographic, and echocardiographic parameters at midterm follow-up.
OBJECTIVE: This study aimed to collect real-world data on LBBAD implantation and follow-up.
METHODS: Retrospective periprocedural and follow-up data on electrocardiographic and electrical parameters, transthoracic echocardiography data, and clinical outcome were assembled from 12 international centers.
RESULTS: In total, 163 patients (age 67 ± 12 years; 137 males) were included. Implantation success rate was 88%. Defibrillation testing was performed in 85 patients and was effective in all cases. Paced unipolar QRS duration was 125 ms (119-135) with a V6 R-wave peak time of 76 ms (70-85) and a V6-V1 interpeak interval of 44 ms (45-54). Capture threshold was 0.8 V/0.4 ms (0.5-1.1), sensing amplitude was 9.0 mV (6.2-12), and pacing and high-voltage impedances were 580 Ω (493-650) and 66 Ω (60-75). Electrical parameters remained favorable over a follow-up of 8 months (3-13). Left ventricular ejection fraction improved from 30% (26%-35%) to 36% (31%-46%) at the last follow-up (P < .001). A total of 13 appropriate and effective shocks were documented, affecting 8 patients (4.9%). No ineffective shocks were reported. 2 LBBAD leads were explanted more than 1 year after implantation without any complication. No deaths were related to LBBAD.
CONCLUSION: LBBAD with standard stylet-driven lead is safe and feasible, with stable electrical, electrocardiographic, and echocardiographic parameters at midterm follow-up.