Arrhythmias & electrophysiology
Delivery System Support Prevents Endocardial Entanglement and Delamination During Left Bundle Branch Area Pacing
- Active fixation of a lumenless screw-in lead into the right ventricular septum was attempted with or without delivery system support using donor human hearts rejected for transplant
- macroscopic and microscopic analyses
+1 more
- macroscopic and microscopic analyses
Authors' conclusion
Endocardial entanglement and delamination were confirmed in donor human hearts. Adequate delivery system support, particularly its coaxiality and counterforce effect, is likely to prevent endocardial entanglement and facilitate effective penetration of a lumenless screw-in lead into the human ventricular septum.
Study context
- Population
- Donor human hearts rejected for transplantdonor human hearts, 10 lead deployments with or without support
- Participants
- 4 hearts
- Comparison
- Lead deployment with vs without delivery system support
- support groupn = 10 total deployments attempted with or without support across both groups
- nonsupport groupn = 10 total deployments attempted with or without support across both groups
Main finding
As reported in the abstract
Endocardial entanglement and resultant helix-only penetration
Further findings
Median endocardial delamination area · larger in the entanglement group
P < 0.001
Delamination after unscrewing following entanglement
- Unscrewing after the endocardial entanglement consistently revealed extensively delaminated endocardium entwined around the helix
Histology
- Regions with endocardial entanglement: extensive endocardial delamination with minimal myocardial injury
- Regions without entanglement: localized endocardial delamination and deep intramural penetration
Reattempted screw-in into regions with extensive delamination
- achieved deep penetration even without delivery system support
Original publication
Delivery System Support Prevents Endocardial Entanglement and Delamination During Left Bundle Branch Area Pacing. Circ Arrhythm Electrophysiol. Published 9 April 2026. doi:10.1161/circep.125.014355
Summarised from the published abstract; every number is checked against it