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A Single Center Experience with Early Adoption of Physiologic Pacing Approaches
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  • Connor Oates,
  • Iwanari Kawamura ,
  • Mohit turagam,
  • Marie-Noelle Langan,
  • Mary McDonaugh,
  • William Whang,
  • Marc Miller,
  • Daniel Musikantow,
  • Srinivas Dukkipati,
  • Vivek Reddy,
  • Jacob Koruth
Connor Oates
Icahn School of Medicine at Mount Sinai

Corresponding Author:[email protected]

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Iwanari Kawamura
Icahn School of Medicine at Mount Sinai
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Mohit turagam
Icahn School of Medicine at Mount Sinai
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Marie-Noelle Langan
Icahn School of Medicine at Mount Sinai
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Mary McDonaugh
Icahn School of Medicine at Mount Sinai
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William Whang
Icahn School of Medicine at Mount Sinai
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Marc Miller
Icahn School of Medicine at Mount Sinai
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Daniel Musikantow
Icahn School of Medicine at Mount Sinai
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Srinivas Dukkipati
Icahn School of Medicine at Mount Sinai
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Vivek Reddy
Icahn School of Medicine at Mount Sinai
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Jacob Koruth
Icahn School of Medicine at Mount Sinai
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Abstract

Background: Increasing interest in physiological pacing has been countered with challenges such as accurate lead deployment and increasing pacing thresholds with His-bundle pacing (HBP). More recently, left bundle branch area pacing (LBBAP) has emerged as an alternative approach to physiologic pacing. Objective: To compare procedural outcomes and pacing parameters at follow-up during initial adoption of HBP and LBBAP at a single center. Methods: Retrospective review, from September 2016 to January 2020, identified the first 50 patients each who underwent successful HBP or LBBAP. Pacing parameters were then assessed at first follow-up after implantation and after approximately one year, evaluating for acceptable pacing parameters defined as sensing R-wave amplitude >5 mV, threshold <2.5 V @ 0.5 ms and impedance between 400 and 1200 Ohms. Results: The HBP group was younger with lower ejection fraction compared to LBBP (73.2±15.3 vs 78.2±9.2 years, p=0.047; 51.0±15.9% vs 57.0±13.1%, p = 0.044). Post-procedural QRS widths were similarly narrow (119.8±21.2 vs. 116.7±15.2ms; p = 0.443) in both groups. Significantly fewer patients with HBP met the outcome for acceptable pacing parameters at initial follow-up (56.0% vs 96.4%, p = 0.001) and most recent follow-up (60.7% vs 94.9%, p = <0.001; at 399±259 vs. 228±124 days, p = <0.001). More HBP patients required lead revision due to early battery depletion (0 vs 13.3%, at an average of 664 days). Conclusion: During initial adoption, as compared with LBBAP, HBP is associated with a significantly higher frequency of unacceptable pacing parameters, energy consumption, and lead revisions.
23 Aug 2021Submitted to Journal of Cardiovascular Electrophysiology
24 Aug 2021Submission Checks Completed
24 Aug 2021Assigned to Editor
24 Aug 2021Reviewer(s) Assigned
14 Sep 2021Review(s) Completed, Editorial Evaluation Pending
18 Sep 2021Editorial Decision: Revise Minor
11 Oct 20211st Revision Received
22 Oct 2021Submission Checks Completed
22 Oct 2021Assigned to Editor
22 Oct 2021Reviewer(s) Assigned
13 Nov 2021Review(s) Completed, Editorial Evaluation Pending
15 Nov 2021Editorial Decision: Accept
Feb 2022Published in Journal of Cardiovascular Electrophysiology volume 33 issue 2 on pages 308-314. 10.1111/jce.15303