Feasibility, safety, and short-term follow-up of defibrillator lead at left bundle branch area pacing location: A pilot study

BACKGROUND Left bundle branch area pacing (LBBAP) has been increasingly adopted as an alternative modality to cardiac resynchronization therapy (CRT). The feasibility and safety of using an LBBAP lead to provide sensing of ventricular arrhythmia in patients receiving an implantable cardioverter-defibrillator (ICD) with CRT has been demonstrated recently. OBJECTIVES The purpose of our study was to analyze the feasibility, safety, and short-term follow-up of a traditional defibrillator lead at the LBBAP location. METHODS Patients who underwent successful LBBAP defibrillator using DF-1/DF-4 lead and delivery catheter were included in the study. Defibrillation threshold (DFT) testing was performed after implantation to assess the ability of the LBBAP defibrillator lead to sense and provide appropriate therapy for ventricular arrhythmia. RESULTS Although the ICD lead could be successfully deployed in the left bundle branch area in 7 of 8 patients, it was repositioned to the right ventricular (RV) apex because of atrial oversensing in 1 patient and cheesy septum in another patient. Acute procedural success was 62.5% (5/8 patients). Mean patient age was 62.6 +/- 21.6 years. Mean procedural duration was 115.6 +/- 38.1 minutes, with LBBAP defibrillator lead fluoroscopy duration of 10.6 +/- 3.5 minutes. Mean capture threshold was 0.58 +/- 0.23V/0.4 ms, sensed R-wave amplitude 9.6 +/- 2.2 mV, pacing impedance 560 +/- 145 S2, and shock impedance 65.4 +/- 5.5 S2. Defibrillation testing was successful in inducing ventricular fibrillation and could be sensed and reverted promptly by the shock delivered through the lead. During mean follow-up of 3.8 +/- 2.2 months, pacing parameters remained stable. No episodes of inappropriate arrhythmia detection or therapy delivery occurred during follow-up. CONCLUSION LBBAP defibrillator is feasible, safe, and effective during short-term follow-up. DFT testing at the time of implantation will help to ensure appropriate sensing and treatment of ventricular arrhythmias.