Technical feasibility of leadless left bundle branch area pacing for cardiac resynchronization: A case series

TY - JOUR

T1 - Technical feasibility of leadless left bundle branch area pacing for cardiac resynchronization

T2 - A case series

AU - Elliott, Mark K.

AU - Jacon, Peggy

AU - Sidhu, Baldeep Singh

AU - Smith, Lucy Jarrett

AU - Mehta, Vishal S.

AU - Gould, Justin

AU - Lee, Angela W.C.

AU - Niederer, Steven

AU - Defaye, Pascal

AU - Rinaldi, Christopher A.

N1 - Publisher Copyright: © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

PY - 2021/11/1

Y1 - 2021/11/1

N2 - Background: Left bundle branch area pacing (LBBAP) is a novel form of conduction system pacing which can reverse left bundle branch block and deliver cardiac resynchronization therapy (CRT). The WiSE-CRT system delivers leadless endocardial pacing with symptomatic and left ventricular (LV) remodelling improvements following intervention. We report the technical feasibility of delivering leadless LBBAP using the WiSE-CRT system. Case summary: In Case 1, a 57-year-old male with ischaemic cardiomyopathy and complete heart block underwent implantation of the WiSE-CRT system, using a retrograde transaortic approach, after failed conventional CRT. Temporary left bundle stimulation from the LV septum achieved superior electrical resynchronization and equivalent haemodynamic response compared to endocardial pacing at the lateral LV wall. In Case 2, an 82-year-old gentleman with tachyarrhythmia-induced cardiomyopathy underwent WiSE-CRT implantation via a trans-septal inter-atrial approach, with the endocardial electrode successfully deployed in the LV septum. Discussion: Here we report the first case of deployment of the WiSE-CRT endocardial electrode in the LV septum and demonstrate the technical feasibility of leadless LBBAP. Entirely leadless CRT is an attractive option for patients with venous access issues or recurrent lead complications and has previously been successful using the WiSE-CRT system and a leadless pacemaker in the right ventricle. Further studies are required to assess long-term efficacy and safety of leadless LBBAP.

AB - Background: Left bundle branch area pacing (LBBAP) is a novel form of conduction system pacing which can reverse left bundle branch block and deliver cardiac resynchronization therapy (CRT). The WiSE-CRT system delivers leadless endocardial pacing with symptomatic and left ventricular (LV) remodelling improvements following intervention. We report the technical feasibility of delivering leadless LBBAP using the WiSE-CRT system. Case summary: In Case 1, a 57-year-old male with ischaemic cardiomyopathy and complete heart block underwent implantation of the WiSE-CRT system, using a retrograde transaortic approach, after failed conventional CRT. Temporary left bundle stimulation from the LV septum achieved superior electrical resynchronization and equivalent haemodynamic response compared to endocardial pacing at the lateral LV wall. In Case 2, an 82-year-old gentleman with tachyarrhythmia-induced cardiomyopathy underwent WiSE-CRT implantation via a trans-septal inter-atrial approach, with the endocardial electrode successfully deployed in the LV septum. Discussion: Here we report the first case of deployment of the WiSE-CRT endocardial electrode in the LV septum and demonstrate the technical feasibility of leadless LBBAP. Entirely leadless CRT is an attractive option for patients with venous access issues or recurrent lead complications and has previously been successful using the WiSE-CRT system and a leadless pacemaker in the right ventricle. Further studies are required to assess long-term efficacy and safety of leadless LBBAP.

KW - Cardiac resynchronization therapy

KW - Case series

KW - Endocardial pacing

KW - Heart failure

KW - Leadless pacing

KW - Left bundle branch area pacing

UR - http://www.scopus.com/inward/record.url?scp=85117914331&partnerID=8YFLogxK

U2 - 10.1093/ehjcr/ytab379

DO - 10.1093/ehjcr/ytab379

M3 - Article

AN - SCOPUS:85117914331

SN - 2514-2119

VL - 5

JO - European Heart Journal - Case Reports

JF - European Heart Journal - Case Reports

IS - 11

M1 - ytab379

ER -