Left bundle branch area pacing with stylet-driven pacing leads: implantation technique
Abstract Background Traditional right ventricular apical pacing can cause electrical–mechanical dyssynchrony. Therefore, physiological conduction system pacing was considered and became the reason for developing His bundle pacing (HBP). Recently, left bundle branch area pacing (LBBAP) has been imple...
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | International Journal of Arrhythmia |
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| Online Access: | https://doi.org/10.1186/s42444-023-00095-1 |
| _version_ | 1797822998215917568 |
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| author | Ga-In Yu Tae-Hoon Kim Hee Tae Yu Boyoung Joung Hui-Nam Pak Moon-Hyoung Lee |
| author_facet | Ga-In Yu Tae-Hoon Kim Hee Tae Yu Boyoung Joung Hui-Nam Pak Moon-Hyoung Lee |
| author_sort | Ga-In Yu |
| collection | DOAJ |
| description | Abstract Background Traditional right ventricular apical pacing can cause electrical–mechanical dyssynchrony. Therefore, physiological conduction system pacing was considered and became the reason for developing His bundle pacing (HBP). Recently, left bundle branch area pacing (LBBAP) has been implemented, which overcomes the shortcomings of HBP. Most initial large LBBAP studies reported that LBBAP was achieved through a lumenless pacing lead (LLL) with a fixed helix design; however, it is unavailable in Korea. LBBAP delivery sheaths using a conventional standard stylet-driven pacing lead (SDL) with an extendable helix design are currently available in Korea. In this review, we describe the methods and procedural skills required to perform the LBBAP using conventional SDL. Main body LBBAP has emerged as a new physiological CSP modality and has shown a stable and lower capture threshold and achieved a similarly paced QRS duration compared to HBP. It has also demonstrated stable early outcomes for feasibility and safety with a high success rate. Furthermore, the application of LBBAP has recently been extended to a resynchronization strategy. The LBBAP with SDL requires different handling and lead preparation owing to differences in lead and helix designs. Reported procedure-related acute complications of LBBAP include septal perforation during the procedure, pneumothorax, pocket infection, pocket hematoma, and lead dislodgements occurring during follow-up. Conclusion LBBAP with conventional SDL has similar implant success rates, procedural safety, and pacing characteristics as LBBAP with LLL. However, LBBAP with SDL requires different handling and lead preparation from that of LLL owing to the differences in the lead and helix designs. |
| first_indexed | 2024-03-13T10:17:24Z |
| format | Article |
| id | doaj.art-20fe4ad32f2d441daf535a8dc8fe217b |
| institution | Directory Open Access Journal |
| issn | 2466-1171 |
| language | English |
| last_indexed | 2024-03-13T10:17:24Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Arrhythmia |
| spelling | doaj.art-20fe4ad32f2d441daf535a8dc8fe217b2023-05-21T11:08:55ZengBMCInternational Journal of Arrhythmia2466-11712023-05-012411710.1186/s42444-023-00095-1Left bundle branch area pacing with stylet-driven pacing leads: implantation techniqueGa-In Yu0Tae-Hoon Kim1Hee Tae Yu2Boyoung Joung3Hui-Nam Pak4Moon-Hyoung Lee5Division of Cardiology, Department of Internal Medicine, GyeongSang National University Changwon Hospital, Gyeongsang National University College of MedicineDivision of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of MedicineDivision of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of MedicineDivision of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of MedicineDivision of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of MedicineDivision of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of MedicineAbstract Background Traditional right ventricular apical pacing can cause electrical–mechanical dyssynchrony. Therefore, physiological conduction system pacing was considered and became the reason for developing His bundle pacing (HBP). Recently, left bundle branch area pacing (LBBAP) has been implemented, which overcomes the shortcomings of HBP. Most initial large LBBAP studies reported that LBBAP was achieved through a lumenless pacing lead (LLL) with a fixed helix design; however, it is unavailable in Korea. LBBAP delivery sheaths using a conventional standard stylet-driven pacing lead (SDL) with an extendable helix design are currently available in Korea. In this review, we describe the methods and procedural skills required to perform the LBBAP using conventional SDL. Main body LBBAP has emerged as a new physiological CSP modality and has shown a stable and lower capture threshold and achieved a similarly paced QRS duration compared to HBP. It has also demonstrated stable early outcomes for feasibility and safety with a high success rate. Furthermore, the application of LBBAP has recently been extended to a resynchronization strategy. The LBBAP with SDL requires different handling and lead preparation owing to differences in lead and helix designs. Reported procedure-related acute complications of LBBAP include septal perforation during the procedure, pneumothorax, pocket infection, pocket hematoma, and lead dislodgements occurring during follow-up. Conclusion LBBAP with conventional SDL has similar implant success rates, procedural safety, and pacing characteristics as LBBAP with LLL. However, LBBAP with SDL requires different handling and lead preparation from that of LLL owing to the differences in the lead and helix designs.https://doi.org/10.1186/s42444-023-00095-1Conduction system pacingLeft bundle branch area pacingStylet-driven pacing lead |
| spellingShingle | Ga-In Yu Tae-Hoon Kim Hee Tae Yu Boyoung Joung Hui-Nam Pak Moon-Hyoung Lee Left bundle branch area pacing with stylet-driven pacing leads: implantation technique International Journal of Arrhythmia Conduction system pacing Left bundle branch area pacing Stylet-driven pacing lead |
| title | Left bundle branch area pacing with stylet-driven pacing leads: implantation technique |
| title_full | Left bundle branch area pacing with stylet-driven pacing leads: implantation technique |
| title_fullStr | Left bundle branch area pacing with stylet-driven pacing leads: implantation technique |
| title_full_unstemmed | Left bundle branch area pacing with stylet-driven pacing leads: implantation technique |
| title_short | Left bundle branch area pacing with stylet-driven pacing leads: implantation technique |
| title_sort | left bundle branch area pacing with stylet driven pacing leads implantation technique |
| topic | Conduction system pacing Left bundle branch area pacing Stylet-driven pacing lead |
| url | https://doi.org/10.1186/s42444-023-00095-1 |
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