Left bundle branch pacing lead for sensing ventricular arrhythmias in implantable cardioverter-defibrillator: A pilot study (LBBP-ICD study)
Left bundle branch pacing (LBBP) has been suggested as an alternative modality for biventricular pacing in cardiac resynchronization therapy (CRT)–eligible patients. As it provides stable R-wave sensing, LBBP has been recently used to provide sensing of ventricular arrhythmia in patients receiving i...
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| Veröffentlicht in: | Heart rhythm 2024-04, Vol.21 (4), p.419-426 |
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| creator | Ponnusamy, Shunmuga Sundaram Ramalingam, Vadivelu Mariappan, Selvaganesh Ganesan, Vithiya Anand, Vijesh Syed, Thabish Murugan, Senthil Kumar, Mahesh Vijayaraman, Pugazhendhi |
| description | Left bundle branch pacing (LBBP) has been suggested as an alternative modality for biventricular pacing in cardiac resynchronization therapy (CRT)–eligible patients. As it provides stable R-wave sensing, LBBP has been recently used to provide sensing of ventricular arrhythmia in patients receiving implantable cardioverter-defibrillator (ICD) with CRT.
The aim of this study was to analyze the long-term safety and efficacy of the LBBP lead for appropriate detection of ventricular arrhythmia and delivery of antitachycardia pacing (ATP) in patients requiring defibrillator therapy with CRT.
CRT-eligible patients who underwent successful LBBP-optimized ICD and LBBP-optimized CRT with defibrillator were enrolled. The LBBP lead was connected to the right ventricular-P/S port after capping the IS-1 connector plug of the DF-1–ICD lead. LBBP-optimized ICD or LBBP-optimized CRT with defibrillator was decided on the basis of correction of conduction system disease. Documented arrhythmic episodes and therapy delivered were analyzed.
Thirty patients were enrolled. The mean age was 59.7 ± 10.5 years. LBBP resulted in an increase in left ventricular ejection fraction from 29.9% ± 4.6% to 43.9% ± 11.2% (P < .0001). During a mean follow-up of 22.9 ± 12.5 months, 254 ventricular arrhythmic events were documented. Appropriate events (n = 225 [89%]) included nonsustained ventricular tachycardia (VT) (n = 212 episodes [94%]), VT (n = 8 [3.5%]), and ventricular fibrillation (n = 5 [2.5%]). ATP efficacy in terminating VT was 75%. Eleven percent of episodes (n = 29) were inappropriately detected because of T-wave oversensing. Inappropriate therapy (ATP) was delivered for 14 episodes (5.5%). Three patients (10%) had worsening of tricuspid regurgitation.
Sensing from the LBBP lead for arrhythmia detection is safe as ∼90% of the episodes were detected appropriately. Future studies with a dedicated LBBP-defibrillator lead along with algorithms to avoid oversensing can help in combining defibrillation with conduction system pacing.
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| doi_str_mv | 10.1016/j.hrthm.2023.12.009 |
| format | Article |
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The aim of this study was to analyze the long-term safety and efficacy of the LBBP lead for appropriate detection of ventricular arrhythmia and delivery of antitachycardia pacing (ATP) in patients requiring defibrillator therapy with CRT.
CRT-eligible patients who underwent successful LBBP-optimized ICD and LBBP-optimized CRT with defibrillator were enrolled. The LBBP lead was connected to the right ventricular-P/S port after capping the IS-1 connector plug of the DF-1–ICD lead. LBBP-optimized ICD or LBBP-optimized CRT with defibrillator was decided on the basis of correction of conduction system disease. Documented arrhythmic episodes and therapy delivered were analyzed.
Thirty patients were enrolled. The mean age was 59.7 ± 10.5 years. LBBP resulted in an increase in left ventricular ejection fraction from 29.9% ± 4.6% to 43.9% ± 11.2% (P < .0001). During a mean follow-up of 22.9 ± 12.5 months, 254 ventricular arrhythmic events were documented. Appropriate events (n = 225 [89%]) included nonsustained ventricular tachycardia (VT) (n = 212 episodes [94%]), VT (n = 8 [3.5%]), and ventricular fibrillation (n = 5 [2.5%]). ATP efficacy in terminating VT was 75%. Eleven percent of episodes (n = 29) were inappropriately detected because of T-wave oversensing. Inappropriate therapy (ATP) was delivered for 14 episodes (5.5%). Three patients (10%) had worsening of tricuspid regurgitation.
Sensing from the LBBP lead for arrhythmia detection is safe as ∼90% of the episodes were detected appropriately. Future studies with a dedicated LBBP-defibrillator lead along with algorithms to avoid oversensing can help in combining defibrillation with conduction system pacing.
[Display omitted]</description><identifier>ISSN: 1547-5271</identifier><identifier>ISSN: 1556-3871</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2023.12.009</identifier><identifier>PMID: 38142831</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adenosine Triphosphate ; Aged ; Arrhythmias, Cardiac - diagnosis ; Arrhythmias, Cardiac - therapy ; Cardiac Conduction System Disease ; Cardiac resynchronization therapy ; Cardiac Resynchronization Therapy - adverse effects ; Cardiac Resynchronization Therapy - methods ; Defibrillators, Implantable - adverse effects ; Heart failure ; Humans ; Left bundle branch pacing ; LOT-CRT-D ; LOT-ICD ; Middle Aged ; Pilot Projects ; Stroke Volume ; T-wave oversensing ; Treatment Outcome ; Ventricular Function, Left</subject><ispartof>Heart rhythm, 2024-04, Vol.21 (4), p.419-426</ispartof><rights>2023 Heart Rhythm Society</rights><rights>Copyright © 2023 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-4745a0e0765ec85f9455f46e4df885d9de769c9dfdfd0303845a7a30b4885f333</citedby><cites>FETCH-LOGICAL-c359t-4745a0e0765ec85f9455f46e4df885d9de769c9dfdfd0303845a7a30b4885f333</cites><orcidid>0000-0002-7059-425X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.hrthm.2023.12.009$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38142831$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ponnusamy, Shunmuga Sundaram</creatorcontrib><creatorcontrib>Ramalingam, Vadivelu</creatorcontrib><creatorcontrib>Mariappan, Selvaganesh</creatorcontrib><creatorcontrib>Ganesan, Vithiya</creatorcontrib><creatorcontrib>Anand, Vijesh</creatorcontrib><creatorcontrib>Syed, Thabish</creatorcontrib><creatorcontrib>Murugan, Senthil</creatorcontrib><creatorcontrib>Kumar, Mahesh</creatorcontrib><creatorcontrib>Vijayaraman, Pugazhendhi</creatorcontrib><title>Left bundle branch pacing lead for sensing ventricular arrhythmias in implantable cardioverter-defibrillator: A pilot study (LBBP-ICD study)</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>Left bundle branch pacing (LBBP) has been suggested as an alternative modality for biventricular pacing in cardiac resynchronization therapy (CRT)–eligible patients. As it provides stable R-wave sensing, LBBP has been recently used to provide sensing of ventricular arrhythmia in patients receiving implantable cardioverter-defibrillator (ICD) with CRT.
The aim of this study was to analyze the long-term safety and efficacy of the LBBP lead for appropriate detection of ventricular arrhythmia and delivery of antitachycardia pacing (ATP) in patients requiring defibrillator therapy with CRT.
CRT-eligible patients who underwent successful LBBP-optimized ICD and LBBP-optimized CRT with defibrillator were enrolled. The LBBP lead was connected to the right ventricular-P/S port after capping the IS-1 connector plug of the DF-1–ICD lead. LBBP-optimized ICD or LBBP-optimized CRT with defibrillator was decided on the basis of correction of conduction system disease. Documented arrhythmic episodes and therapy delivered were analyzed.
Thirty patients were enrolled. The mean age was 59.7 ± 10.5 years. LBBP resulted in an increase in left ventricular ejection fraction from 29.9% ± 4.6% to 43.9% ± 11.2% (P < .0001). During a mean follow-up of 22.9 ± 12.5 months, 254 ventricular arrhythmic events were documented. Appropriate events (n = 225 [89%]) included nonsustained ventricular tachycardia (VT) (n = 212 episodes [94%]), VT (n = 8 [3.5%]), and ventricular fibrillation (n = 5 [2.5%]). ATP efficacy in terminating VT was 75%. Eleven percent of episodes (n = 29) were inappropriately detected because of T-wave oversensing. Inappropriate therapy (ATP) was delivered for 14 episodes (5.5%). Three patients (10%) had worsening of tricuspid regurgitation.
Sensing from the LBBP lead for arrhythmia detection is safe as ∼90% of the episodes were detected appropriately. Future studies with a dedicated LBBP-defibrillator lead along with algorithms to avoid oversensing can help in combining defibrillation with conduction system pacing.
[Display omitted]</description><subject>Adenosine Triphosphate</subject><subject>Aged</subject><subject>Arrhythmias, Cardiac - diagnosis</subject><subject>Arrhythmias, Cardiac - therapy</subject><subject>Cardiac Conduction System Disease</subject><subject>Cardiac resynchronization therapy</subject><subject>Cardiac Resynchronization Therapy - adverse effects</subject><subject>Cardiac Resynchronization Therapy - methods</subject><subject>Defibrillators, Implantable - adverse effects</subject><subject>Heart failure</subject><subject>Humans</subject><subject>Left bundle branch pacing</subject><subject>LOT-CRT-D</subject><subject>LOT-ICD</subject><subject>Middle Aged</subject><subject>Pilot Projects</subject><subject>Stroke Volume</subject><subject>T-wave oversensing</subject><subject>Treatment Outcome</subject><subject>Ventricular Function, Left</subject><issn>1547-5271</issn><issn>1556-3871</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcmOEzEQhlsIxCzwBEjIx-HQjddekDjMhAFGigQHOFtuu0wc9UbZHSnvwEPjkIEj8sGu8lf1l_0XxStGK0ZZ_XZf7TDtxopTLirGK0q7J8UlU6ouRduwp6ezbErFG3ZRXMW4p5R3NRXPiwvRMslbwS6LX1vwifTr5AYgPZrJ7shibJh-kAGMI35GEmGKp8QBpoTBroNBYhB3x6weTCRhImFcBjMl0-cu1qAL8wEwAZYOfOgxDINJM74jt2QJw5xITKs7kpvt3d3X8mHz4Ry_eVE882aI8PJxvy6-f7z_tvlcbr98etjcbksrVJdK2UhlKNCmVmBb5TuplJc1SOfbVrnOQVN3tnM-LyqoaDPeGEF7ma-9EOK6uDn3XXD-uUJMegzRQh5ygnmNmndUNS3vmMyoOKMW5xgRvF4wjAaPmlF9skHv9R8b9MkGzbjONuSq148Caz-C-1fz998z8P4MQH7mIQDqaANMFlxAsEm7OfxX4Dcqf5vA</recordid><startdate>202404</startdate><enddate>202404</enddate><creator>Ponnusamy, Shunmuga Sundaram</creator><creator>Ramalingam, Vadivelu</creator><creator>Mariappan, Selvaganesh</creator><creator>Ganesan, Vithiya</creator><creator>Anand, Vijesh</creator><creator>Syed, Thabish</creator><creator>Murugan, Senthil</creator><creator>Kumar, Mahesh</creator><creator>Vijayaraman, Pugazhendhi</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7059-425X</orcidid></search><sort><creationdate>202404</creationdate><title>Left bundle branch pacing lead for sensing ventricular arrhythmias in implantable cardioverter-defibrillator: A pilot study (LBBP-ICD study)</title><author>Ponnusamy, Shunmuga Sundaram ; Ramalingam, Vadivelu ; Mariappan, Selvaganesh ; Ganesan, Vithiya ; Anand, Vijesh ; Syed, Thabish ; Murugan, Senthil ; Kumar, Mahesh ; Vijayaraman, Pugazhendhi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-4745a0e0765ec85f9455f46e4df885d9de769c9dfdfd0303845a7a30b4885f333</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adenosine Triphosphate</topic><topic>Aged</topic><topic>Arrhythmias, Cardiac - diagnosis</topic><topic>Arrhythmias, Cardiac - therapy</topic><topic>Cardiac Conduction System Disease</topic><topic>Cardiac resynchronization therapy</topic><topic>Cardiac Resynchronization Therapy - adverse effects</topic><topic>Cardiac Resynchronization Therapy - methods</topic><topic>Defibrillators, Implantable - adverse effects</topic><topic>Heart failure</topic><topic>Humans</topic><topic>Left bundle branch pacing</topic><topic>LOT-CRT-D</topic><topic>LOT-ICD</topic><topic>Middle Aged</topic><topic>Pilot Projects</topic><topic>Stroke Volume</topic><topic>T-wave oversensing</topic><topic>Treatment Outcome</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ponnusamy, Shunmuga Sundaram</creatorcontrib><creatorcontrib>Ramalingam, Vadivelu</creatorcontrib><creatorcontrib>Mariappan, Selvaganesh</creatorcontrib><creatorcontrib>Ganesan, Vithiya</creatorcontrib><creatorcontrib>Anand, Vijesh</creatorcontrib><creatorcontrib>Syed, Thabish</creatorcontrib><creatorcontrib>Murugan, Senthil</creatorcontrib><creatorcontrib>Kumar, Mahesh</creatorcontrib><creatorcontrib>Vijayaraman, Pugazhendhi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ponnusamy, Shunmuga Sundaram</au><au>Ramalingam, Vadivelu</au><au>Mariappan, Selvaganesh</au><au>Ganesan, Vithiya</au><au>Anand, Vijesh</au><au>Syed, Thabish</au><au>Murugan, Senthil</au><au>Kumar, Mahesh</au><au>Vijayaraman, Pugazhendhi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Left bundle branch pacing lead for sensing ventricular arrhythmias in implantable cardioverter-defibrillator: A pilot study (LBBP-ICD study)</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2024-04</date><risdate>2024</risdate><volume>21</volume><issue>4</issue><spage>419</spage><epage>426</epage><pages>419-426</pages><issn>1547-5271</issn><issn>1556-3871</issn><eissn>1556-3871</eissn><abstract>Left bundle branch pacing (LBBP) has been suggested as an alternative modality for biventricular pacing in cardiac resynchronization therapy (CRT)–eligible patients. As it provides stable R-wave sensing, LBBP has been recently used to provide sensing of ventricular arrhythmia in patients receiving implantable cardioverter-defibrillator (ICD) with CRT.
The aim of this study was to analyze the long-term safety and efficacy of the LBBP lead for appropriate detection of ventricular arrhythmia and delivery of antitachycardia pacing (ATP) in patients requiring defibrillator therapy with CRT.
CRT-eligible patients who underwent successful LBBP-optimized ICD and LBBP-optimized CRT with defibrillator were enrolled. The LBBP lead was connected to the right ventricular-P/S port after capping the IS-1 connector plug of the DF-1–ICD lead. LBBP-optimized ICD or LBBP-optimized CRT with defibrillator was decided on the basis of correction of conduction system disease. Documented arrhythmic episodes and therapy delivered were analyzed.
Thirty patients were enrolled. The mean age was 59.7 ± 10.5 years. LBBP resulted in an increase in left ventricular ejection fraction from 29.9% ± 4.6% to 43.9% ± 11.2% (P < .0001). During a mean follow-up of 22.9 ± 12.5 months, 254 ventricular arrhythmic events were documented. Appropriate events (n = 225 [89%]) included nonsustained ventricular tachycardia (VT) (n = 212 episodes [94%]), VT (n = 8 [3.5%]), and ventricular fibrillation (n = 5 [2.5%]). ATP efficacy in terminating VT was 75%. Eleven percent of episodes (n = 29) were inappropriately detected because of T-wave oversensing. Inappropriate therapy (ATP) was delivered for 14 episodes (5.5%). Three patients (10%) had worsening of tricuspid regurgitation.
Sensing from the LBBP lead for arrhythmia detection is safe as ∼90% of the episodes were detected appropriately. Future studies with a dedicated LBBP-defibrillator lead along with algorithms to avoid oversensing can help in combining defibrillation with conduction system pacing.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38142831</pmid><doi>10.1016/j.hrthm.2023.12.009</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-7059-425X</orcidid></addata></record> |
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| ispartof | Heart rhythm, 2024-04, Vol.21 (4), p.419-426 |
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| subjects | Adenosine Triphosphate Aged Arrhythmias, Cardiac - diagnosis Arrhythmias, Cardiac - therapy Cardiac Conduction System Disease Cardiac resynchronization therapy Cardiac Resynchronization Therapy - adverse effects Cardiac Resynchronization Therapy - methods Defibrillators, Implantable - adverse effects Heart failure Humans Left bundle branch pacing LOT-CRT-D LOT-ICD Middle Aged Pilot Projects Stroke Volume T-wave oversensing Treatment Outcome Ventricular Function, Left |
| title | Left bundle branch pacing lead for sensing ventricular arrhythmias in implantable cardioverter-defibrillator: A pilot study (LBBP-ICD study) |
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