Novel left ventricular cardiac synchronization: left ventricular septal pacing or left bundle branch pacing?

Abstract It is well recognized that a high burden of right ventricular pacing results in deleterious clinical outcomes over the long term. His bundle pacing can achieve optimal ventricular synchronization; however, relatively high pacing thresholds, low R-wave amplitudes, and the long-term performance have been concerns. Recently, left ventricular (LV) septal endocardium pacing (LVSP) has demonstrated improved acute haemodynamics. Another novel technique of intraseptal left bundle branch pacing (LBBP) via transvenous approach has been adopted rapidly and has demonstrated its feasibility and effectiveness. This article reviews the clinical application and differences between LVSP and LBBP. Compared with LVSP, LBBP has strict criteria for left conduction system capture and lead location. In addition to LV septal capture it also stimulates the proximal left bundle branch, resulting in rapid and physiological LV activation. With a uniformity and standardization of the implant procedure and definitions, it may be possible to achieve widespread application of this form of physiological pacing.

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Long-Term Performance of the Attain Model 4193 Left Ventricular Lead

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.2009.02451.x ◽

2009 ◽

Vol 32 (9) ◽

pp. 1111-1116 ◽

Cited By ~ 6

Author(s):

W. BEN JOHNSON ◽

WILLIAM T. ABRAHAM ◽

JAMES B. YOUNG ◽

KEVIN WHEELAN ◽

ANDREW L. SMITH ◽

...

Keyword(s):

Left Ventricular ◽

Left Ventricular Lead ◽

Ventricular Lead ◽

Long Term Performance ◽

Term Performance

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Improved long-term performance of pulsatile extracorporeal left ventricular assist device

Journal of Cardiology ◽

10.1016/j.jjcc.2010.05.010 ◽

2010 ◽

Vol 56 (2) ◽

pp. 220-228 ◽

Cited By ~ 16

Author(s):

Taro Sasaoka ◽

Tomoko S. Kato ◽

Kazuo Komamura ◽

Ayako Takahashi ◽

Ikutaro Nakajima ◽

...

Keyword(s):

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Left Ventricular ◽

Assist Device ◽

Ventricular Assist ◽

Left Ventricular Assist ◽

Long Term Performance ◽

Term Performance

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P1492Comparison of the long-term performance of the quadripolar IS-4 and the bipolar IS-1 left ventricular lead for cardiac resynchronization therapy

EP Europace ◽

10.1093/europace/euaa162.179 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

J Maurhofer ◽

H Tanner ◽

A Haeberlin ◽

F Noti ◽

J Seiler ◽

...

Keyword(s):

Retrospective Study ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Phrenic Nerve Stimulation ◽

All Cause Mortality ◽

Long Term Performance ◽

Term Performance ◽

Lead Dislodgement

Abstract BACKGROUND The implantation of left ventricular (LV) leads for cardiac resynchronization therapy (CRT) and the management of lead-related complications can be challenging. The introduction of the quadripolar IS-4 LV lead may have facilitated the implantation procedure and may have reduced lead-related complications. Data of long-term follow-up (FU) comparing the IS-4 lead with the IS-1 LV lead are rare and conflicting. PURPOSE Comparison of lead-related complications and all-cause mortality between CRT patients who received an IS-4 or an IS-1 LV lead in the long-term FU. METHODS Adults with an indication for a CRT-Defibrillator or CRT-Pacemaker, a successful endovascular IS-4 or IS-1 LV lead implantation, and a minimal FU of three years were included in this retrospective study. The combined primary endpoint was freedom from lead-related complications defined as (i) occurrence of persisting high pacing threshold (>2.75V/0.4ms), (ii) unresolved phrenic nerve stimulation, (iii) LV lead dislodgement/disruption, (iv) the necessity of re-interventions affecting the LV lead, and (v) LV lead deactivation/explantation. Secondary endpoints were all singular complications and all-cause mortality. RESULTS Eligible for the study were 133 patients (IS-4 n = 66; IS-1 n = 67) with a mean FU of 4.03 ± 1.93 years. Baseline characteristics of both patient groups did not differ significantly. Freedom from lead-related complications was higher in patients with an IS-4 lead as compared to an IS-1 lead (Figure 1; 87.9% vs. 65.7%; p = 0.002). The secondary outcomes showed a higher rate of LV lead dislodgement/disruption (4.5% vs. 17.9%; p = 0.015) in the IS-1 patient group and more patients suffered from unresolved phrenic nerve stimulation with an IS-1 lead (3.0% vs. 13.4%; p = 0.029). LV lead deactivation/explantation during FU and LV lead-related re-interventions were fewer in case of an IS-4 lead (4.5% vs 22.4%; p = 0.003; 6.1% vs. 17.9%; p = 0.036, respectively). The rate of persisting high pacing thresholds and all-cause mortality did not differ (4.5% vs. 9.0%; p = 0.492; 22.7% vs 25.4%; p = 0.721, respectively). CONCLUSION The quadripolar IS-4 LV lead showed in this retrospective study a better long-term performance than the bipolar IS-1 lead. Abstract Figure 1

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