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Caveats related to conduction system pacing utilizing a proprietary deflectable mapping catheter with a stylet-driven lead

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Hitherto, lumen less leads (LLLs) were routinely utilized for conduction system pacing (CSP). We report the largest experience using stylet-driven leads (SDLs) with a deflectable mapping catheter for CSP.

Methods

Patients were prospectively and sequentially enrolled for CSP with SDL between June, 2021 and November, 2022 to (i) a novel deflectable mapping catheter (AgilisHisProTM, Abbott) (Group A) or (ii) a fixed curve sheath (Selectra3D, Biotronik) (Group B) in a 1:1 non-randomized fashion. The primary aim was to evaluate safety, feasibility, and efficacy of the CSP using SDL and deflectable mapping catheter (Group A) while reporting procedural success and intermediate-term follow-up.

Results

Seventy-nine patients (59.4%M, mean age 67.2+/−10.6 years) were allocated to either (i) Group A (n = 40) or (ii) Group B (n = 39). In Group A (n = 40, 50% M, mean age 67.2+/−9.5 years, follow-up 210.7 + 25.1days), His bundle pacing (HBP) was the default strategy with left bundle branch area pacing (LBBaP) for bailout. Procedural success with HBP was feasible in 17/40 (42.5%) patients with remaining 23/40 (57.5%) needing LBBaP bailout. After initial learning curve, a manual septal curve was introduced to successfully aid LBBaP in 6/23 (26.1%) cases. Procedural and follow-up parameters did not differ significantly in HBP vs. LBBaP. Head-to-head comparison was not performed between the groups owing to different default protocols (HBP−Group A, Discretionary−Group B).

Conclusions

Use of SDL with single-curve deflectable mapping catheter was safe, feasible and yielded moderate procedural success with HBP and frequently needed a LBBaP bailout strategy. In approximately one-fourth of the latter, an out-of-plane manual septal curve was needed to optimize LBBaP.

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Authors and Affiliations

  1. Department of Cardiac Electrophysiology and Pacing, Arrhythmia Heart Failure Academy, The Madras Medical Mission, 4-A, Dr. JJ Nagar, Mogappair, Chennai, Tamil Nadu, India

    Anindya Ghosh, Mohamed Akram KA & Ulhas M. Pandurangi

  2. Division of Cardiology, Sub-section of Electrophysiology, Children’s Hospital of Michigan and Detroit Medical Center, Detroit, MI, USA

    Chenni S. Sriram

Authors
  1. Anindya Ghosh
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  2. Mohamed Akram KA
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  3. Chenni S. Sriram
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  4. Ulhas M. Pandurangi
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Corresponding author

Correspondence to Ulhas M. Pandurangi.

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Ethics approval and consent to participate

The study was granted approval by Institutional Ethics committee (Madras Medical Mission) and complies with the guidelines laid in the ‘1964 Declaration of Helsinki’. Informed consent was obtained from all patients

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The authors declare no competing interests.

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Supplementary information

Online Resource 1 Septogram showing lead perforation across the septum and contrast tracking along the lead to the left ventricular cavity (MP4 643 kb)

Online Resource 2 Septogram showing lead penetration into septal tributary of anterior interventricular vein and ultimately draining into the coronary sinus (MP4 5294 kb)

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Ghosh, A., KA, M., Sriram, C.S. et al. Caveats related to conduction system pacing utilizing a proprietary deflectable mapping catheter with a stylet-driven lead. J Interv Card Electrophysiol (2023). https://doi.org/10.1007/s10840-023-01637-2

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  • DOI: https://doi.org/10.1007/s10840-023-01637-2

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