Left bundle branch pacing–optimized implantable cardioverter-defibrillator (LOT-ICD) for cardiac resynchronization therapy: A pilot study
Shunmuga Sundaram Ponnusamy, Vadivelu Ramalingam, Vithiya Ganesan, Thabish Syed, Mahesh Kumar, Selvaganesh Mariappan, Senthil Murugan, William Basil, Pugazhendhi Vijayaraman
Abstract
Left bundle branch pacing (LBBP) involves direct capture of left bundle fibers by placing the lead deep inside the interventricular septum. Several studies have shown the feasibility and efficacy of LBBP as an alternative modality for cardiac resynchronization therapy (CRT). This paper describes approach for providing cost effective CRT with defibrillator (CRT-D) by LBBP and dual chamber implantable cardioverter defibrillator (ICD) which we label as LBBP optimized ICD (LOT-ICD). LBBP was performed using C315 sheath and 3830 Selectsecure lead in all patients by premature ventricular complex guided approach. In patients with complete correction of conduction system disease, IS-1 connector plug of the IS-1/DF-1 lead was capped and 3830 lead connected to the dual chamber ICD pulse-generator at RV-P/S port. LOT-ICD provided stable R-wave sensing for arrhythmia monitoring and resulted in cost-effective resynchronization therapy at reduced fluoroscopy duration and radiation dose. Left bundle branch pacing (LBBP) involves direct capture of left bundle fibers by placing the lead deep inside the interventricular septum. Several studies have shown the feasibility and efficacy of LBBP as an alternative modality for cardiac resynchronization therapy (CRT). This paper describes approach for providing cost effective CRT with defibrillator (CRT-D) by LBBP and dual chamber implantable cardioverter defibrillator (ICD) which we label as LBBP optimized ICD (LOT-ICD). LBBP was performed using C315 sheath and 3830 Selectsecure lead in all patients by premature ventricular complex guided approach. In patients with complete correction of conduction system disease, IS-1 connector plug of the IS-1/DF-1 lead was capped and 3830 lead connected to the dual chamber ICD pulse-generator at RV-P/S port. LOT-ICD provided stable R-wave sensing for arrhythmia monitoring and resulted in cost-effective resynchronization therapy at reduced fluoroscopy duration and radiation dose. Key Findings▪Left bundle branch pacing–optimized implantable cardioverter-defibrillator (LOT-ICD) is a novel approach for providing cost-effective cardiac resynchronization therapy using a dual-chamber implantable cardioverter-defibrillator (ICD) and left bundle branch pacing.▪LOT-ICD was successful in 57.9% of the population eligible for cardiac resynchronization therapy–defibrillator with reduced fluoroscopy duration and radiation dose.▪The low success rate could be due to extensive scar burden in a highly selected population as detected by cardiac magnetic resonance imaging.▪Pacing parameters remained stable during mean follow-up of 13.9 ± 8.7 months, with no episodes of inappropriate ICD discharges. ▪Left bundle branch pacing–optimized implantable cardioverter-defibrillator (LOT-ICD) is a novel approach for providing cost-effective cardiac resynchronization therapy using a dual-chamber implantable cardioverter-defibrillator (ICD) and left bundle branch pacing.▪LOT-ICD was successful in 57.9% of the population eligible for cardiac resynchronization therapy–defibrillator with reduced fluoroscopy duration and radiation dose.▪The low success rate could be due to extensive scar burden in a highly selected population as detected by cardiac magnetic resonance imaging.▪Pacing parameters remained stable during mean follow-up of 13.9 ± 8.7 months, with no episodes of inappropriate ICD discharges.