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Journal ArticleDOI

Left bundle branch pacing: A comprehensive review.

TL;DR: Left bundle branch pacing (LBBP) has been suggested as an effective alternative to overcome the limitations of HBP as it provides low and stable pacing threshold, lead stability, and correction of distal conduction system disease.
Abstract: Cardiac pacing is the only effective therapy for patients with symptomatic bradyarrhythmia. Traditional right ventricular apical pacing causes electrical and mechanical dyssynchrony resulting in left ventricular dysfunction, recurrent heart failure, and atrial arrhythmias. Physiological pacing activates the normal cardiac conduction, thereby providing synchronized contraction of ventricles. Though His bundle pacing (HBP) acts as an ideal physiological pacing modality, it is technically challenging and associated with troubleshooting issues during follow-up. Left bundle branch pacing (LBBP) has been suggested as an effective alternative to overcome the limitations of HBP as it provides low and stable pacing threshold, lead stability, and correction of distal conduction system disease. This paper will focus on the implantation technique, troubleshooting, clinical implications, and a review of published literature of LBBP.
Citations
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Journal ArticleDOI
TL;DR: In this paper, the authors established electrocardiographic (ECG) criteria for LBB capture and showed equivalency of LV activation times on ECG during native and paced LBB conduction.

77 citations

Journal ArticleDOI
TL;DR: In this article, the feasibility and outcomes of LBBAP-optimized CRT (LOT-CRT) combined with coronary venous left ventricular pacing were evaluated in an international multicenter study.

67 citations

Journal ArticleDOI
TL;DR: In this paper , the feasibility and outcomes of CRT based on left bundle branch area pacing (LBBAP, in lieu of the right ventricular lead) combined with coronary venous left ventricular pacing in an international multicenter study were evaluated.

67 citations

Journal ArticleDOI
TL;DR: The anatomy of the cardiac conduction system is reviewed, some of the recently published articles that aid in better understanding of the AV conduction axis and its variations are highlighted, and the differences seen clinically with His bundle pacing and left bundle branch area pacing are discussed.
Abstract: The specialized cardiomyocytes that constitute the conduction system in the human heart, initiate the electric impulse and result in rhythmic and synchronized contraction of the atria and ventricles. Although the atrioventricular (AV) conduction axis was described more than a century ago by Sunao Tawara, the anatomic pathway for propagation of impulse from atria to the ventricles has been a topic of debate for years. Over the past 2 decades, there has been a resurgence of conduction system pacing (CSP) by implanting pacing leads in the His bundle region in lieu of chronic right ventricular pacing that is associated with worse clinical outcomes. The inherent limitations of implanting the leads in the His bundle region has led to the emergence of left bundle branch area pacing in the past 3 years as an alternative strategy for CSP. The clinical experience from performing CSP has helped electrophysiologists gain deeper insight into the anatomy and physiology of cardiac conduction system. This review details the anatomy of the cardiac conduction system, and highlights some of the recently published articles that aid in better understanding of the AV conduction axis and its variations, the knowledge of which is critical for CSP. The remarkable evolution in technology has led to visualization of the cardiac conduction system using noninvasive, nondestructive high-resolution contrast-enhanced micro-computed tomography imaging that may aid in future CSP. We also discuss from anatomical perspective, the differences seen clinically with His bundle pacing and left bundle branch area pacing.

53 citations

Journal ArticleDOI
TL;DR: In this article, the ectopic beats with qR/rsRʹ morphology in lead V1 (fixation beats) during lead fixation were investigated to predict whether the desired intraseptal lead depth had been reached, whereas the lack of fixation beats would indicate a too shallow position and the need for more lead rotations.

46 citations

References
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Journal ArticleDOI
Bruce L. Wilkoff1, James R. Cook, Andrew E. Epstein2, Leon Greene, Alfred P. Hallstrom, Henry H. Hsia, Steven P. Kutalek, Arjun Sharma, Brian Blatt, Barry Karas, James Kirchhoffer, Deborah Warwick, Mary Duquette, Jean Provencher, Maureen Redmond, John M. Herre, Robert S. Bernstein, Linette R. Klevan, Kathleen D. Barackman, Jennine Zumbuhl, Mina K. Chung1, Fredrick J. Jaeger1, David O. Martin1, Andrea Natale1, Walid Saliba1, Robert A. Schweikert1, Mark Niebauer1, Patrick J. Tchou1, Raquel Rozich1, Marc Roelke, Constantinos A. Costeas, Donald G. Rubenstein, Scott Ruffo, Kelly Kumar, Elizabeth McCarthy, Valerie Pastore, Mark S. Wathen3, Jeffrey N. Rottman3, Mark Anderson3, John T. Lee3, Katherine T. Murray3, Dan M. Roden3, Nancy Conners3, Sandy Saunders3, Gearoid P. O'Neill4, Anne Skadsen4, Shelley Allen4, Ellie Vierra4, Stephen Greer, Jeffrey Neuhauser, Pam Myers, Celeste Lee, Terri Moore, Richard C. Klein5, Roger A. Freedman5, Geri Wadsworth5, Sharon M. Dailey2, G. Neal Kay2, Vance J. Plumb2, Rosemary S. Bubien2, Linda W. Kay2, Candace M. Nasser2, Jane E. Slabaugh2, Robert B. Leman6, Jenifer L. Lake6, Julie Clark6, Elizabeth Clarke6, Laura Finklea6, John C. Love7, Charles M. Carpenter7, Andrew Corsello7, Joel E. Cutler7, Susan BosworthFarrell7, Gregory Michaud8, Alfred E. Buxton8, Kristin E. Ellison8, Frederic Christian8, Malcolm Kirk8, Pamela L. Corcoran8, Stephen T. Rothbart9, Roy B. Sauberman9, Jennifer McCarthy9, Mary Ellen Page9, Jonathan S. Steinberg, Frederick Ehlert, Bengt Herweg, Margot Vloka, Ammy Malinay, Edith Menchavez, Michael Rome, Kathy Marks, Alison Swarens, Maribel Hernandez, Roger A. Marinchak, Douglas Esberg, John Finkle, Glenn Harper, Peter R. Kowey, Colin Movsowitz 
25 Dec 2002-JAMA
TL;DR: For patients with standard indications for ICD therapy, no indication for cardiac pacing, and an LVEF of 40% or less, dual-chamber pacing offers no clinical advantage over ventricular backup pacing and may be detrimental by increasing the combined end point of death or hospitalization for heart failure.
Abstract: CONTEXT: Implantable cardioverter defibrillator (ICD) therapy with backup ventricular pacing increases survival in patients with life-threatening ventricular arrhythmias. Most currently implanted ICD devices provide dual-chamber pacing therapy. The most common comorbid cause for mortality in this population is congestive heart failure. OBJECTIVE: To determine the efficacy of dual-chamber pacing compared with backup ventricular pacing in patients with standard indications for ICD implantation but without indications for antibradycardia pacing. DESIGN: The Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial, a single-blind, parallel-group, randomized clinical trial. SETTING AND PARTICIPANTS: A total of 506 patients with indications for ICD therapy were enrolled between October 2000 and September 2002 at 37 US centers. All patients had a left ventricular ejection fraction (LVEF) of 40% or less, no indication for antibradycardia pacemaker therapy, and no persistent atrial arrhythmias. INTERVENTIONS: All patients had an ICD with dual-chamber, rate-responsive pacing capability implanted. Patients were randomly assigned to have the ICDs programmed to ventricular backup pacing at 40/min (VVI-40; n = 256) or dual-chamber rate-responsive pacing at 70/min (DDDR-70; n = 250). Maximal tolerated medical therapy for left ventricular dysfunction, including angiotensin-converting enzyme inhibitors and beta-blockers, was prescribed to all patients. MAIN OUTCOME MEASURE: Composite end point of time to death or first hospitalization for congestive heart failure. RESULTS: One-year survival free of the composite end point was 83.9% for patients treated with VVI-40 compared with 73.3% for patients treated with DDDR-70 (relative hazard, 1.61; 95% confidence interval [CI], 1.06-2.44). The components of the composite end point, mortality of 6.5% for VVI-40 vs 10.1% for DDDR-70 (relative hazard, 1.61; 95% CI, 0.84-3.09) and hospitalization for congestive heart failure of 13.3% for VVI-40 vs 22.6% for DDDR-70 (relative hazard, 1.54; 95% CI, 0.97-2.46), also trended in favor of VVI-40 programming. CONCLUSION: For patients with standard indications for ICD therapy, no indication for cardiac pacing, and an LVEF of 40% or less, dual-chamber pacing offers no clinical advantage over ventricular backup pacing and may be detrimental by increasing the combined end point of death or hospitalization for heart failure.

1,922 citations


Additional excerpts

  • ...Chronic right ventricular (RV) pacing is known to cause deleterious effects in the form of atrial arrhythmias, left ventricular (LV) dysfunction, and recurrent heart failure hospitalization.(1) The alternative sites such as septum and RV outflow tract have not shown consistent results in improving the clinical outcomes....

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Journal ArticleDOI
TL;DR: Permanent DHBP is feasible in select patients who have chronic atrial fibrillation and dilated cardiomyopathy and results in a reduction of left ventricular dimensions and improved cardiac function.
Abstract: Background—Direct His-bundle pacing (DHBP) produces synchronous ventricular depolarization and improved cardiac function relative to apical pacing. Although it has been performed transiently in the electrophysiology laboratory and persistently in open-chested canines, permanent DHBP in humans has not been achieved. Methods and Results—A total of 18 patients aged 69±10 years who had a history of chronic atrial fibrillation, dilated cardiomyopathy, and normal activation (ie, QRS≤120 ms) were screened for permanent DHBP using an electrophysiology catheter. In 14 patients, the His bundle could be reliably stimulated. Of these 14, permanent DHBP using a fixed screw-in lead was successful in 12 patients. Radiofrequency atrioventricular node ablation was performed in patients exhibiting a fast ventricular response. All patients received single-chamber rate-responsive pacemakers. Acute pacing thresholds were 2.4±1.0 V at a pulse duration of 0.5 ms. Lead complications included exit block requiring reoperative adju...

605 citations


"Left bundle branch pacing: A compre..." refers background in this paper

  • ...Chronic right ventricular (RV) pacing is known to cause deleterious effects in the form of atrial arrhythmias, left ventricular (LV) dysfunction, and recurrent heart failure hospitalization.1 The alternative sites such as septum and RV outflow tract have not shown consistent results in improving the clinical outcomes.2,3 His bundle pacing (HBP) has emerged as an ideal form of physiological pacing, as it activates the normal cardiac conduction system resulting in synchronized contraction of ventricle, thereby avoiding RV pacing‐related complications.4 Deshmukh et al.5 first reported the feasibility of permanent HBP using conventional RV leads with manually shaped stylets....

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  • ...Deshmukh et al.(5) first reported the feasibility of permanent HBP using conventional RV leads with manually shaped stylets....

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Journal ArticleDOI
TL;DR: The case shows a novel pacing strategy for patients with BBB that affects many patients with heart failure, and demonstrates the feasibility of pacing the left bundle branch (LBB) immediately beyond the conduction block to functionally restore the impaired His-Purkinje conduction system.

450 citations

Journal ArticleDOI

370 citations


"Left bundle branch pacing: A compre..." refers methods in this paper

  • ...Though several studies have shown its feasibility and efficacy, concerns regarding lead stability, higher threshold, and early battery depletion has limited its widespread clinical application.6 Huang et al.,7 first demonstrated the direct capture of left bundle (LB) by placing the lead deep inside the septum resulting in synchronized activation of ventricles....

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  • ...However, HBP at high output by dual‐lead technique as suggested by Huang et al.(10) with a second 3830 lead will correct LBBB and restore LB activation to produce LB potential....

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  • ...5‐ms pulse width).(10) Commonly, the 4....

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  • ...Huang et al.28 reported 97% success rate in a prospective multicenter study involving 63 patients with nonischemic cardiomyopathy and LBBB along with normalization of left ventricular ejection fraction (LVEF > 50...

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  • ...However, HBP at high output by dual‐lead technique as suggested by Huang et al.10 with a second 3830 lead will correct LBBB and restore LB activation to produce LB potential....

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Journal ArticleDOI
TL;DR: Permanent His-bundle pacing may be considered as a rescue strategy for failed BVP and may be a reasonable primary alternative to BVP for CRT.

296 citations

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