Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Maatschap cardiologie Isala Zwolle
Right ventricular apical pacing (RVAP) is associated with an increased incidence of heart failure, caused by dyssynchronous activation. Left bundle branch area pacing (LBBAP) is an alternative physiological pacing technique. However, evidence on LBBAP is limited. Moreover, most LBBAP has been performed with the lumenless, bipolar, permanent pacing lead, with a fixed helix. Although several case reports described the successful use of a standard stylet-driven lead, only one trial compared a stylet-driven active fixation lead to the Medtronic 3830 lead.
The aim of this analysis was to compare the non-stylet driven Medtronic 3830 (MDT) to a standard stylet-driven active fixation lead in terms of pacing parameters, success and complication rates. In this ongoing observational study, 84 patients received a LBBAP in the period of December 2019 until December 2020. The majority received a right ventricular (RV) lead as back-up. A subgroup of 80 patients was selected, including all patients who received the MDT (41.3%) or Tendril lead (58.8%) and had at least a 2-week follow-up period.
In both groups 1 LBBAP lead positioning was not successful; 2.1% (Tendril) versus 3.0% (MDT). One patient had a Tendril lead dislocation (2.1%) and therefore switched to the back-up RV lead. The success rate of LBBAP lead performance was comparable, p = 0.632. Complication rate was comparable in both groups, p = 0.441. Mean number of deployments, lead implantation and procedural time did not differ significantly, for Tendril respectively 2.8 ± 2.5 deployments, 47 ± 26 and 107 ± 32 minutes. MDT showed 3.8 ± 3.3 deployments, 48 ± 36 and 123 ± 47 minutes, p-values 0.058, 0.399 and 0.172. Mean sensing amplitude (mV) and pacing threshold (V) were comparable, although Tendril pacing impedance was significantly lower; 439 ± 207 Ohm versus 594 ± 202 Ohm with MDT, p = 0.001.
There was no learning effect in the MDT group, comparing the first ten and last ten implantations in implantation time, success rate, number of deployments and complications. The Tendril group showed significantly shorter lead implantation time in the last ten implantations compared to the first ten: 28 ± 15 versus 63 ± 34 minutes, p = 0.002. The last ten Tendril leads were implanted significantly faster than the last ten MDT leads, p = 0.035, with mean lead implantation time for MDT 45 ± 22 minutes.
This analysis demonstrates that there are no differences in complications, lead implantation time and number of deployments in LBBAP implantation between MDT and Tendril, although Tendril showed a significant learning effect in lead implantation time. Moreover, success rate did not differ significantly. Pacing impedance was significantly lower in the Tendril group, however this did not result in clinically relevant outcomes. Further research should focus on long-term differences between these leads in terms of pacing parameters and lead failure.
A long-term, prospective, cohort study on the performance of right ventricular pacing leads: comparison of active-fixation with passive-fixation leads
