A novel semi-quantitative slack adjustment technique for left bundle branch area pacing resulted in stable electrical parameters and improved LVEF from 37.3% to 42.8% over a median 8.26 months.
Observational (n=133)
No
Does a novel semi-quantitative slack adjustment technique for LBBAP leads result in stable electrical parameters and acceptable tricuspid valve function?
A novel semi-quantitative method for adjusting lead slack during LBBAP appears feasible, maintaining stable electrical parameters and showing a low rate of significant tricuspid regurgitation worsening.
Abstract Background In cardiac implantable electronic devices (CIEDs), lead slack impacts interaction with the tricuspid valve, but there are no specific recommendations regarding this. Aim To present a new practical, semi-quantitative method for determining optimal lead slack during lead implantation procedures. Methods This single-center study included consecutive patients from November 2021 to February 2025 who underwent left bundle branch area pacing (LBBAP). Slack size was evaluated at the level of the superior vena cava (SVC): A) Initially, the lead should be in a slightly pulled position, similar to the right atrial lead. B) The stylet should be withdrawn from the LBBAP lead. C) The LBBAP lead should then be advanced until it reaches the lateral wall of the SVC (Figure 1, yellow arrow). D)The lead should be further advanced until its middle portion (right atrial level) forms an inverted loop toward the septum (Figure 1, red arrow). Results A total of 133 patients were enrolled. The mean age was 65.9 ± 16.04 years, and 28.57% were female. Among the participants, 84.9% had heart failure and 35.3% had left bundle branch block. The mean QRS duration was 160.32 ± 39.05 ms. A total of 45.1% received CRT-D devices, 34% received single- or dual-chamber devices, 17.8% received CRT-P devices, and 3.1% received LOT-CRT devices. Additionally, 28.6% were upgrade procedures, while 71.4% were new implantations. A total of 94 patients were followed regularly in our outpatient clinic, with a median follow-up of 8.26 ± 6.97 months. At implantation, the mean stimulated QRS duration, V6 RWPT, and V1–V6 interpeak interval were 131.36 ± 17.36 ms, 77.41 ± 18.44 ms, and 39.78 ± 17.62 ms, respectively. Electrical parameters and ECG measurements remained stable at follow-up. Left ventricular ejection fraction improved from 37.3 ± 11.9% at baseline to 42.8 ± 12.4% after implantation. At baseline, 7 patients had tricuspid regurgitation (TR) grade 3 or higher. Worsening of TR was observed in 10 patients (10.6%): 8 patients (8.51%) progressed from grade 1 to 2, 1 patient (1.05%) from grade 2 to 4, and 1 patient (1.05%) from grade 3 to 4. In 8 patients (8.51%), TR improved. Conclusion Appropriate lead slack appears to be of critical importance in LBBAP, particularly given the specific positioning requirements of the lead. This new practical method may help reduce complications associated with lead implantation.A- initial Position. B- End Position. Slack formation, Anatomy.
Bocchini et al. (Sat,) conducted a observational in Patients undergoing left bundle branch area pacing (LBBAP) (n=133). Semi-quantitative method for determining optimal lead slack was evaluated. A novel semi-quantitative slack adjustment technique for left bundle branch area pacing resulted in stable electrical parameters and improved LVEF from 37.3% to 42.8% over a median 8.26 months.