Arrhythmias & electrophysiology
LOCAlizaTion and clinical corrElation of Left Bundle Branch Pacing lead: Insights from a computed tomographic angiography (LOCATE left bundle branch pacing (LBBP)) study
Authors' conclusion
Deep septal deployment of the lead in the LV subendocardium for LBB capture is safe, with 94% of patients showing consistent conduction system capture during follow-up.
Study context
- Population
- Consecutive patients with successful LBBP using a lumenless lead (excluded: no left bundle branch (LBB) capture, contrast allergy, renal dysfunction)of 105 with computed tomographic angiography (CTA) after LBBP
- Participants
- 67 patients
- Outcome
- Consistent LBB capture with helix tip <2 mm from LV blood pool by CTA
- Follow-up
- 6 months
Methodological detailsconsecutive patients, CT angiography follow-up, Mean follow-up 33.8 ± 4.4 months
- Consecutive patients
- CT angiography follow-up
- Mean follow-up 33.8 ± 4.4 months
Main finding
As reported in the abstract
Primary endpoint achieved
89.5%
n = 60
Observational data: associations, not effects.
Secondary outcomes
Loss of conduction system capture (LOCSC) predictors
| OR (95% CI) | P value | ||
|---|---|---|---|
| Lack of nonselective to selective capture transition during implantation | 18.0 (1.7–192.7) | P = 0.01 | |
| 0.050.21520Odds ratio (log scale) |
- LOCSC predictors — Lead displacement >2 mm away from left ventricular (LV) blood pool: sensitivity
- 100%
- LOCSC predictors — Lead displacement >2 mm away from LV blood pool: specificity
- 95%
Consistent LBB capture (group I) · 6 months
- Consistent LBB capture
- 94% (n = 63)
Loss of conduction system capture (LOCSC, group 2) · 6 months
- LOCSC
- 6% (n = 4)
Lead stability: mean distance LV blood pool to helix tip, postimplant vs 6 months
- No difference in mean distance (−0.5 ± 1.8 mm vs −0.1 ± 2.1 mm)
- P = 0.23
Nonselective to selective capture transition
- Nonselective to selective capture transition
- 82% (n = 55)
Safety
Perforation into LV cavity with complete loss of capture · 6 months
- No perforation into the LV cavity with complete loss of capture
Original publication
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