Abstract
Abstract Objectives Although Left Bundle Branch Area Pacing (LBBAP) is emerging conduction system pacing modality, it is unclear which parameters are predictive of procedural success and how many screwing attempts are acceptable. This retrospective observational study sought to assess predictors of successful LBBAP, left bundle branch (LBB) capture, and factors associated with the number of screwing attempts. Methods We performed a multicenter retrospective analysis of 120 patients who underwent LBBAP with stylet driven lead. We analyzed factors affecting the number of screwing attempts and procedural success. Procedural, 12-lead ECG, echocardiographic parameters and clinical variables were used in multivariate analyses. Results LBBAP success rate was 95.8% (115/120), and LBB capture success rate was 86.1% (99/115). Few screwing attempts was associated with procedural success (2.1 ± 1.2, 2.7 ± 1.2, and 3.5 ± 1.3 in LBBAP with LBB capture, LBBAP without LBB capture and failed LBBAP group, respectively) (p for trends=0.03). 4 or more screwing attempt was independently associated with higher complication rate compared to fewer screwing attempt (n≤3) (p<0.05). The larger RA size (B = 1.901, 95% confidence interval [CI] 1.07 - 2.73, p <0.001), smaller RV size (B = -0.995, 95% CI -1.88 - -0.31, p = 0.007), and intraventricular conduction delay (IVCD) at pre-implant ECG were independently associated with more screwing attempts. Larger RA size (4th quartile) was associated with larger final sheath size and frequent sheath size change to larger sheath when compared to others. Conclusions More screwing attempts was associated with failed LBBAP procedure and failed LBB capture, and 4 or more screw attempts was associated with higher complication rate. Larger the RA size, smaller the RV size, and IVCD in pre-implant ECG are predictive of more screwing attempt.
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