Allied Professionals (Non-physician submissions only) -> Teaching Case Reports D-MP03 - From Patients to Procedures: The Spectrum of Care (ID 23) Moderated ePoster

D-MP03-06 - The Value of Unipolar and Bipolar Testing in Left Bundle Branch Pacing Device Follow up (ID 34)

 S.M. Ellison: Nothing relevant to disclose.


Background: Left bundle branch pacing (LBBP) has emerged as an option for patients requiring a high percentage of pacing in order to maintain ventricular synchrony. We present the case of a 71 year old man with history of complete heart block who presented for a His bundle lead revision due to loss of His capture and underwent successful LBBP implant. In follow-up he was noted to have increased thresholds and a unipolar morphology change.
Objective: Frequent monitoring post implant of patients with LBBP can identify changes in pacing morphology that may correlate with possible lead migration.
Methods: After successful implantation of an LBBP with acceptable thresholds and LBB capture achieved with both pacing polarities, we followed the device and lead parameters closely.
Results: At implant, the 3830 (Medtronic, Inc.) lead demonstrated good LBB capture with narrow QRS with both unipolar and bipolar pacing (Fig. 1A,C). At the 2 week follow-up, both unipolar and bipolar LBB capture thresholds increased significantly (Figure 1) and unipolar QRS morphology widened (Fig. 1D), exhibiting possible LV septal capture. Bipolar QRS remained narrow, capturing LBB (Fig. 1B). One possible explanation for this finding is lead advancement with the screw partially protruding through the septum resulting in loss of LBB engagement with unipolar tip pacing but not with bipolar pacing. The patient continues with close follow-up during this acute stage post implant and is scheduled for an echocardiogram to assess the helix depth in the septum.
Conclusion: Patients implanted with LBBP leads should undergo frequent follow-up with both unipolar and bipolar pacing to assess for changes as a marker of septal perforation.