PO-05-047 METHODOLOGY OF VENTRICULAR SEPTAL PACING USING STYLET-DRIVEN LEAD AND THREE-DIMENSIONAL GUIDING CATHETER

Abstract

Superiority of conduction system pacing is recognized and need for septal/physiological pacing is emerging. Recently, catheter-guided implantation of stylet-driven lead(SDL) was introduced to clinical use. The present study was carried out to investigate the acute efficacy and safety of different strategies of catheter-guided ventricular septal implantations of SDL compared to apical implantation. We retrospectively analyzed consecutive patients who underwent implantation of ventricular leads, including both apical implantations and initial experience of septal implantations. The paced QRS duration was compared between 4 groups: G1(apical implantation), G2(septal with fluoroscopic guidance), G3(septal with echo-guidance), G4(septal with echo-guidance and additional lead-body rotation). Body rotation was performed to purpose deep septal pacing. We also performed multivariate analysis to find predictors of short QRS duration less than 130ms during ventricular pacing. In total, 80 patients were analyzed. Selectra3D catheter was exclusively used to implant conventional screw-in leads into septum. Eight physicians (6 in-training and 2 experienced) implanted all the ventricular leads. The number of patients in G1,G2,G3,and G4 were 21,12,29,and 19, respectively. In-procedural or post-procedural dislodgement of septal lead was less frequently in G3/G4 compared to G2(2% vs. 21%). The QRS duration were 161±15,146±13,140±11,and 132±18ms, respectively.(Figure) As for echo-guided implantation cohorts (G2 and G3), multivariate analysis revealed body-rotation(OR: 5.72(95%CI: 1.46-22.4), P=0.012) and experienced physician (OR:5.48(95%CI: 1.16-25.8), P=0.031) were significantly associated with short QRS duration. Combination of echocardiographic guidance and body-rotation could be effective to improve procedural and clinical results after catheter-guided septal implantation of SDLs.