Procedure feasibility and mid-term follow-up of left bundle branch area pacing using stylet-driven pacing leads with a fixed-curve delivery sheath in patients with structural heart disease

Abstract

Abstract Background Recently, left bundle branch area pacing (LBBAP) has been performed using style-driven extendable screw-in leads with newly introduced pre-shaped delivery sheath in South Korea. There are limited data on the feasibility of LBBAP in patients with structural heart disease (SHD). Purpose To evaluate LBBAP procedure feasibility and mid-term follow-up data of LBBAP lead profile in pateints with SHD Methods Patients, in which LBBAP was attempted, were consecutively enrolled at the Seoul National University Hospital from January 2021 to December 2022. LBBAP was performed with stylet-driven lead (Solia S60, Biotronik) delivered through a delivery sheath (Selectra 3D, Biotronik). Procedure feasibility, LBBAP success rate, and mid-term LBBAP lead threshold were evaluated in patients with or without various type of SHD. Results A total of 121 patients were enrolled (mean age 73.5±12.2 years). Atrioventricular block was the most common indication (n=94, 77.7%), followed by atrial fibrillation with slow ventricular rate (n=12, 9.9%), sick sinus syndrome (n=10, 8.3%), and heart failure indicated cardiac resynchronized therapy (n=5, 4.1%). LBBAP success rate was 89.3% of total study population, deep septal pacing was achieved in 4.1%, and right ventricle apex pacing were performed in 6.6%. Fifty-one patients (42.1%) were accompanied by SHD (Figure). Patients with SHD had significantly lower left ventricular ejection fraction than those without SHD (54±13% vs. 62±5%, p<0.001). Baseline QRS duration was longer in patients with SHD (107±26 ms vs. 135±35 ms, p=0.005). Although LBBAP success rate was significantly lower in patients with SHD than those without in total study population (80.4% vs. 95.7%, p=0.007), LBBAP success rate was not differ between two groups after excluding first 30 cases (98.1% in patients without SHD vs. 97.4% in patients with SHD, p=0.811) (Figure). Among patients with successful LBBAP, total procedure time was longer in pateints with SHD, but there was no significant difference of fluoroscopic time, bipolar V sensing, V pacing threshold, and V impedance between the two groups (Figure). Pateints with SHD had longer left ventricular activation time (LVAT) (80±13ms vs. 72±9 msec, p=0.003), but there was no statistically significant difference in the final QRS duration between the two groups (104±14 ms in patients without SHD vs. 111±14 msec in patients with SHD, p=0.955). During mean 19±6 months follow-up, there was no significant V threshold increase in both groups. Conclusion LBBAP using stylet-driven pacing leads in patients with SHD is feasible and safe as in patients without structural heart disease, even by an early experienced operator with LBBAP procedure.