PO-708-06 FEASIBILITY OF RIGHT SIDED LEFT BUNDLE BRANCH AREA PACEMAKER INSERTION: A SINGLE CENTER PROSPECTIVE STUDY

Abstract

Conduction system pacing with the left bundle branch area (LBBAP) is gaining traction as an alternative to traditional right ventricular (RV) pacing. Current implantation systems are designed for insertion through left axillary venous system, which is not always feasible. To evaluate the feasibility of right sided LBBAP lead implantations. Consecutive patients undergoing LBBAP implantation between Feb 2019 and July 2021 at Virginia Commonwealth University were analyzed. Laterality of site access and success rates were recorded. Baseline patient characteristics were tabulated. A total of 422 patients with LBBAP had procedural data available. 408 patients underwent left-sided device insertion with a success rate of 92% and 14 patients underwent right-sided insertion with a success rate of 79% (P=0.10, Table 1). Baseline demographics and indications for pacemaker implantation are listed in Table 1. Patients with right-sided implants were more likely to be referred for CRT (36% vs 9%, p=0.01) and had left bundle branch block (46% vs 14%, p=0.01) compared with left-sided implants. Procedural times were longer in right-sided implants compared with left-sided implants (113±27 vs 93±31 minutes, p=0.02). There was no difference in the mean LVAT and paced QRSd between right sided and left sided implants (Table 2). Lead parameters such as sensing, thresholds and impedances were comparable between the 2 groups. There was no difference in complications. LBBAP success rates may be influenced by the laterality of device insertion. Equipment designed specifically for right-sided implantation may improve success rates, but larger patient populations will be needed to confirm these results. Operator experience with right sided implants is also likely to affect success rates.View Large Image Figure ViewerDownload Hi-res image Download (PPT)