Implantation of standard defibrillator leads in the left bundle branch area: Experience from an international cohort.

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.