Left bundle branch pacing–optimized implantable cardioverter-defibrillator (LOT-ICD) for cardiac resynchronization therapy: A pilot study

Figures

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  Figure 1. Left bundle branch pacing (LBBP)–optimized implantable cardioverter-defibrillator (ICD) (LOT-ICD). A: IS-1/DF-1 lead was implanted in right ventricle (RV). IS-1 connector plug was capped, and 3830 lead was connected to the dual-chamber ICD pulse generator at the RV-P/S port. B: LOT-ICD resulted in significant reduction in QRS duration, as well as improvement in left ventricular ejection fraction (LVEF) and reduction in left ventricular end-diastolic diameter (LVEDD). RAA = right atrial appendage.

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  Figure 2. LOT-ICD for dilated cardiomyopathy with left bundle branch block. LBBP resulted in reduction in QRS duration from 156 ms (A) to 108 ms (D). Note the right bundle branch delay pattern due to LBBP along with T-wave memory. B: Left anterior oblique (LAO) view showing the positions of the IS-1/DF-1 and LBBP leads in the interventricular septum. C: Computed tomographic angiographic image showing the relationship of the LBBP and IS-1/DF-1 leads to the noncoronary cusp (NCC). Note the stent in the left circumflex artery (LCX) immediately behind the NCC. RA = right atrium; other abbreviations as in Figure 1.

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  Figure 3. Left bundle branch pacing lead electrogram (EGM) during follow-up showing nonselective to selective capture transition (arrowhead) at near-threshold output. AP = atrial paced; EGM = electrogram; LECG = lead electrocardiography; MA = marker; VP = ventricular paced.

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  Figure 4. A, B: Cardiac magnetic resonance imaging (cMRI) in a patient with successful left bundle branch pacing–optimized implantable cardioverter-defibrillator (LOT-ICD). Late gadolinium enhancement (LGE) was noted in the basal inferior and inferolateral wall of the left ventricle (white arrow). Basal septum at the site of lead deployment did not have scar. C, D: cMRI in a patient with unsuccessful LOT-ICD. Extensive scar was noted in the septum as evidenced by LGE (white arrow).