Cardiovascular Implantable Electronic Devices -> Leads & Electrodes: -> Implantation D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-225 - AV Junction Ablation In Patients With The Conduction System Pacing Leads: A Comparison Of His Bundle Vs Left Bundle Branch Area Pacing Leads (ID 150)


Background: Conduction system pacing (CSP) leads (His bundle pacing- HBP or left bundle branch area pacing- LBBAP) provides physiologic pacing in patients with drug/ablation-refractory AF undergoing atrioventricular junction (AVJ) ablation. Small single center studies have shown the feasibility of HBP in patients undergoing AVJ ablation.
Objective: To compare the pacing lead and procedural characteristics in patients with HBP and LBBAP leads undergoing AVJ ablation.
Methods: Consecutive patients with CSP leads referred for AVJ ablation between 10/2015 - 11/2019 were included. Pre and post-ablation pacing and lead characteristics, success rates, procedural characteristics, and complications were assessed.
Results: AVJ ablation was performed in 63 patients with CSP leads:14 LBBAP lead and 49 HBP lead. There was no significant difference in demographics between the two groups. The success rates of procedure were 100% vs 89% (5 failed cases) ((p=0.02) in presence of LBBA vs HBP leads. Between the LBBAP and HBP groups: mean procedure time (min) was 25 ± 24.8 and 32 ± 23.8 (p=0.18), total ablation time (min) was 3.0 ± 2.5 and 4.6 ± 4.6 (p=0.04), RF time to heart block (min) was 1.4 ± 2.3 and 3.4 ± 4.7 (p=0.02). QRSd (ms) pre-ablation was 116.6 ± 9.5 and 112.3 ± 23 (p=0.25), and post-ablation was 130.3 ± 8.2 and 126.6 ± 22.5 (p=0.4). There were 4 (8%) complications in the HBP group, all related to increased pacing thresholds with 3 (6%) patients requiring lead revisions. No complications were seen in the LBBAP group.
Conclusion: AVJ ablation in the presence of a HBP lead can be challenging. The presence of a LBBA lead allows for a shorter ablation time along with less complications and repeat ablations.