Aims Left bundle branch area pacing (LBBAP) can be technically challenging and fluoroscopy-intense. Three-dimensional electroanatomical mapping (EAM) facilitates non-fluoroscopic lead navigation... Show moreAims Left bundle branch area pacing (LBBAP) can be technically challenging and fluoroscopy-intense. Three-dimensional electroanatomical mapping (EAM) facilitates non-fluoroscopic lead navigation and electrogram mapping. We sought to prospectively evaluate the feasibility, safety, and outcomes of routine EAM-guided LBBAP in patients with structural heart disease (SHD) and advanced conduction abnormalities. Methods and results Consecutive patients with SHD and conduction abnormalities who underwent an attempt at EAM-guided LBBAP were included. The feasibility, safety, procedural, and mid-term outcomes were evaluated. Electrical, echocardiographic, and clinical parameters were assessed at implantation and last follow-up. Thirty-two patients (68 +/- 18 years; 19% female) were included, of which 75% had intrinsic QRS > 150 ms, 53% left bundle branch block, and 25% right bundle branch block. Primary EAM-guided LBBAP was successful in 29 patients (91%). The procedural duration was 95 (70-110) min, total fluoroscopy time 0.93 (0.40-1.73) min, and total fluoroscopy dose 35.4 (20.5-77.2) cGy cm2. Paced QRS duration (QRSd) was significantly shorter than intrinsic QRSd (121.9 +/- 10.7 vs. 159.2 +/- 34.4 ms; P < 0.001) and remained stable during the mean follow-up of 7.0 +/- 5.9 months. The LBBAP capture threshold was 0.57 +/- 0.23 V/0.4 ms at implantation and remained low during follow-up (0.58 +/- 0.18 V/0.5 +/- 0.2 ms; P = 0.877). Overall left ventricular ejection fraction improved significantly from 44.2 +/- 14.3% at baseline to 49.4 +/- 13.1% at follow-up (P = 0.009), New York Heart Association class from 2.4 +/- 0.6 to 1.8 +/- 0.6 (P = 0.002), respectively. No complications occurred that required intervention. Conclusion Routine near-zero fluoroscopy EAM-guided LBBAP can safely be performed in patients with SHD and advanced conduction abnormalities with high success rates and favourable mid-term outcomes. Further studies are needed to investigate whether the use of EAM improves the overall outcome of conduction system pacing and to identify specific patient populations who benefit the most from EAM-guided lead implantation. Show less
Feijen, M.; Egorova, A.D.; Velde, E.T. van der; Schalij, M.J.; Beeres, S.L.M.A. 2022
In the Netherlands, the coronavirus disease 2019 (COVID-19) pandemic has resulted in excess mortality nationwide. Chronic heart disease patients are at risk for a complicated COVID-19 course. The... Show moreIn the Netherlands, the coronavirus disease 2019 (COVID-19) pandemic has resulted in excess mortality nationwide. Chronic heart disease patients are at risk for a complicated COVID-19 course. The current study investigates all-cause mortality among cardiac implantable electronic device (CIED) patients during the first peak of the pandemic and compares the data to the statistics for the corresponding period in the two previous years. Data of adult CIED patients undergoing follow-up at the Leiden University Medical Centre were analysed. All-cause mortality between 1 March and 31 May 2020 was evaluated and compared to the data for the same period in 2019 and 2018. At the beginning of the first peak of the pandemic, 3,171 CIED patients (median age 70 years; 68% male; 41% ischaemic aetiology) were alive. Baseline characteristics of the 2019 (n = 3,216) and 2018 (n = 3,169) cohorts were comparable. All-cause mortality during the peak of the pandemic was 1.4% compared to 1.6% and 1.4% in the same period in 2019 and 2018, respectively (p = 0.84). During the first peak of the COVID-19 pandemic, there was no substantial excess mortality among CIED patients in the Leiden area, despite the fact that this is group at high risk for a complicated course of a COVID-19 infection. Strict adherence to the preventive measures may have prevented substantial excess mortality in these vulnerable patients. Show less
Akhoundi, F.H.; Contarino, M.F.; Fasano, A.; Vaidyanathan, J.; Ziaee, M.; Tabatabaee, S.N.; Rohani, M. 2021
As the number of patients implanted with deep brain stimulation systems increases, coexistence with cardiac implantable electronic devices (CIEDs) poses questions about safety. We systematically... Show moreAs the number of patients implanted with deep brain stimulation systems increases, coexistence with cardiac implantable electronic devices (CIEDs) poses questions about safety. We systematically reviewed the literature on coexisting DBS and CIED. Eighteen reports of 34 patients were included. Device-device interactions were reported in 6 patients. Sources of complications were extensively reviewed and cautious measures which could be considered as part of a standard checklist for careful consideration are suggested. Show less
