Cardiovascular Implantable Electronic Devices -> Bradycardia Devices: -> Indications D-PO03 - Poster Session III (ID 48) Poster

D-PO03-085 - Pacing Of The Conduction System As First Line Therapy: Single Centre Experience (ID 1098)


Background: His Bundle Pacing (HBP) and Left Bundle Branch Pacing (LBBP) ensure the physiologic ventricular activation and can prevent detrimental effects of apical pacing. The evidences both clinical and technical supporting these new pacing modalities are rapidly increasing. Physicians are currently adopting the pacing of the conduction system (CSP) in selected patients.
Objective: To analyse feasibility of the conduction system pacing (HBP and LBBP) implemented as first line therapy in all patients referred for PM implant.
Methods: The analysis includes 164 consecutive pts (78±9 years; 124 males) with pacing indication, coming from a single operator experience who has adopted CSP as first line approach in all patients. The pts received S-HBP (37%), NS-HBP (47%) or LBBP pacing (16%) by the 3830 lead, from 2018 to 2019 July. The pacing indications were: AV block 62%, sinus node disease 12%, slow atrial fibrillation 12%, heart failure 14%. Ischemic cardiopathy was present in 28%; hypertension in 83%, diabetes in 25%. Baseline QRS duration was 136±36 ms. 60% of pts had bundle branch block. Baseline mean EF 56±12%. 75% pts were in sinus rhythm at implant. The back-up lead was implanted in apex or septum in 18 (11%) patients. A lead in the coronary sinus was placed in 18 (11%) as part of CRT implant.
Results: PMs were checked 48 hours and 1 month after implant, as usual in our centre. At 1 month follow-up 158 (96,4 %) patients showed good performance of the 3830 lead with QRS morphology and duration similar to the post implant ECG (115 ±21 ms). Mean VP% was 64% and mean AP% 40%. VP>90% was detected in 65% of pts. Chronic AF (AT/AF 100%) in 22% of pts. Mean threshold was 1,5V@0,6 ms, mean sensing 5,6 mV and mean impedance 469 ohm. The device’s check revealed 3830 lead malfunction in 6 patients (3,6%) due high threshold (zero macroscopic dislodgement). In 2 (1,6%) of these cases the operator decided to extract 3830 lead and to implant a standard lead in RV septum.
Conclusion: The pacing of the conduction system, both HBP and LBBP are safe and feasible as first line therapy in the overall pts referred for PM implant. The system ensures a physiologic ventricular contraction thus allowing a better clinical outcome. 1,6% of re-intervention due to 3830 lead malfunction were required during 1 month follow up.