PO-03-043 IMPLANTABLE CARDIOVERTER DEFIBRILLATOR THERAPY WITH LEFT BUNDLE AREA PACING DELIVERS HIGHLY SUCCESSFUL ANTITACHYCARDIA PACING THERAPY FOR VENTRICULAR TACHYCARDIA AND SUCCESSFUL DEFIBIRILLATION

Abstract

Left bundle area pacing (LBAP) has emerged as a promising therapy for cardiac resynchronization. However, the effects of LBAP when used as the primary sensing and antitachycardia pacing lead for implantable cardioverter defibrillator (ICD) therapy is unknown. There are potential disadvantages of using a separate pace/sense lead as the defibrillator lead integrity alerts are not maintained and dislodgement may not be known. Additionally, DF1 leads add complexity and points of failure to an ICD system. Examine the outcomes of using a LBAP lead as the pace/sense lead in ICD therapy. A retrospective review of all patients with implanted LBAP leads for ICD therapy was performed. In all cases a DF1 defibrillator lead was used with the pace/sense portion capped and a LBAP lead used. All devices were Abbott (Ellipse, Fortify, Quadra assura). In some cases simultaneous LBAP and CS pacing was performed. Medtronic 3830 leads were used for LBAP. Outcomes included VT events, ATP, and defibrillator therapy. Programming was left ot operator discretion but when no prior history of VT was known a monitor rate of 170 and treatment rate of 200 was programmed. 65 patients were identified with 45 ICDs and 20 cardiac resynchronization therapy defibrillators (CRTDs) since January of 2020. The median follow up time was 13 months. There were 138 VT/VF episodes during the study period occuring in 10 patients. 7 episodes were adjudicated to be SVT and 2 led to inappropriate shocks (1.5%). VT cycle length was 317±31 ms (rate: 191±17 bpm) withATP was delivered in 126 episodes and successfully terminated 120 (95%) of episodes. Per patient success was 90% with an average 1.3 ATP attempts. 5 appopriate shocks were delivered with 100% success. ICD therapy with a LBAP pacing lead as the primary pace/sense lead delivers highly effective ATP and ICD therapy. The rate of successful ATP is significantly higher than previous studies of ATP which have generally ranged from 50-70%. There are several plausible reasons for this including a more rapid and synchronous depolarization of the ventricle rendering more of the ventricle refractory. The small number of shocks were successful. There were no lead dislodgements or issues with sensing. These findings merit further study into the role of LBAP for ICD and ATP therapy.