Abstract 13583: Conduction System Pacing Experience: His Bundle vs. Left Bundle Branch Area Pacing at Columbia University

Abstract

Introduction: Conduction system pacing (CSP) with His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) are utilized as alternatives to RV endocardial and biventricular pacing. Which patients gain the most benefit from CSP remains an area of active investigation. Objective: To report on the early experience with HBP and LBBAP conduction system pacing at an academic medical center. Methods: All patients with a Medtronic 3830 SelectSecure lead implanted from 3/2016 to 5/2022 at Columbia University were selected for chart review. Patients were excluded if follow up interrogation or clinical data were unavailable for review. Results: A total of 36 patients were included and 3 were excluded for lack of follow up. 25 patients had HBP and 11 patients had LBBAP (Table 1). Average time from implant to most recent interrogation for HBP was 530.8 ± 506.2 days, range 22 - 1589, compared to 113.6 ± 149.6 days, range 10 - 397, for LBBAP. The implant threshold was significantly higher in HBP compared to LBBAP (1.58 ± 1.06 V vs. 0.57 ± 0.19 V, p=0.004) (Table 1). There were increased threshold in both groups at follow up compared to initial implant HBP (1.81 ± 1.19 V vs 1.58 ± 1.06, p=0.17) and LLBAP (< 30 days of follow up [n=4], 0.84 ± 0.66 V vs 0.58 ± 0.22 V,p=0.46; >30 days of follow up [n = 7], 1.34 ± 1.40 vs 0.57 ± 0.19, p=0.18) although it was not significant. Complication rates were low, one HBP lead was deactivated due to high threshold, two LBBAP patients required lead revision, one for dislodgement and one for pocket infection. Conclusions: CSP is a feasible and safe procedure. Higher thresholds were observed in the HBP group at implant compared to the LBBAP group. There was a trend of an increased threshold over time in both groups. Ongoing monitoring of the LBBAP is crucial for long term feasibility.