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Left Bundle Branch Area Pacing guided by Continuous Uninterrupted Monitoring of the unipolar Pacing Characteristics.
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  • Kris Gillis,
  • Jean-Yves Wielandts,
  • Gabriela Hilfiker,
  • Louisa O'Neill,
  • Alina Vlase,
  • Sebastien Knecht,
  • Mattias Duytschaever,
  • Rene Tavernier,
  • Jean-Benoit le Polain de Waroux
Kris Gillis
AZ Sint-Jan Brugge-Oostende AV
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Jean-Yves Wielandts
AZ Sint-Jan AV
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Gabriela Hilfiker
AZ Sint-Jan Brugge-Oostende AV
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Louisa O'Neill
AZ Sint-Jan Brugge-Oostende AV
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Alina Vlase
CHwapi
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Sebastien Knecht
AZ Sint-Jan Brugge-Oostende AV
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Mattias Duytschaever
AZ Sint-Jan Brugge-Oostende AV
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Rene Tavernier
AZ Sint-Jan Brugge-Oostende AV
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Jean-Benoit le Polain de Waroux
AZ Sint-Jan Brugge-Oostende AV
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Abstract

Introduction. During left bundle branch area pacing (LBBAP) lead implantation, intermittent monitoring of unipolar pacing characteristics validates LBB capture and can detect septal perforation. We aimed to demonstrate that continuous uninterrupted unipolar pacing from an inserted lead stylet (LS) is feasible and facilitates LBBAP implantation. Methods. Thirty patients (mean age 76 ± 14 years) were implanted with stylet-driven pacing lead (Biotronik Solia S60). In 10 patients (validation-group) conventional, interrupted implantation was performed, with comparison of unipolar pacing characteristics between LS and connector-pin (CP)-pacing after each rotation step. In 20 patients (feasibility-group) performance and safety of uninterrupted implantation during continuous pacing from the LS were analyzed. Results. In the validation-group, LS and CP-pacing impedances were highly correlated (R2=0.95, p<0.0001, bias 12±37Ω). Pacing characteristics from LS and CP showed comparable sensed electrograms and paced QRS morphologies. In the feasibility-group, continuous LS-pacing allowed beat-to-beat monitoring of impedance and QRS morphology to guide implantation. This resulted in successful LBBAP in all patients, after a mean of 1±0 attempts, with mean threshold 0.81 ± 0.4V, median sensing 6.5mV [IQR 4.4-9.5] and mean impedance 624 ± 101Ω, and positive LBBAP-criteria with median paced QRS duration 120ms [IQR 112-152ms] and median pLVAT 73ms [IQR 68-80.5ms]. No septal perforation occurred. Conclusion. Unipolar pacing from the LS allows accurate determination of pacing impedance and generates similar paced QRS morphologies and equal sensed electrograms, compared to CP pacing. Continuous LS pacing allows real-time monitoring of impedance and paced QRS morphology, which facilitates a safe and successful LBBAP lead implantation.

Peer review status:IN REVISION

08 Jul 2021Submitted to Journal of Cardiovascular Electrophysiology
12 Jul 2021Assigned to Editor
12 Jul 2021Submission Checks Completed
19 Jul 2021Reviewer(s) Assigned
09 Aug 2021Review(s) Completed, Editorial Evaluation Pending
10 Aug 2021Editorial Decision: Revise Minor