Po-01-074 use of electro-anatomic mapping to reduce the number of lead deployment attempts for optimal left bundle area pacing: a case series

Left bundle area pacing (LBP) often requires multiple lead deployments into the interventricular septum to find an ideal site with left bundle capture. Evaluate the use of 3-dimensional electro-anatomical mapping system (3D map) to aid in the identification of the correct implant site to achieve optimal left bundle branch capture. Three consecutive patients requiring pacing for AV block with LVEF 40-45% are included in this case series. After ultrasound-guided axillary vein access, a decapolar catheter was advanced and visualized using Carto (DecaNav, Biosense Webster). Intracardiac anatomy was defined using fast activation mapping in the region of the bundle of His and right ventricular septum. High- and low-output pacing was delivered from each of the electrode pairs of the decapolar catheter while it abutted the septum. Ideal deployment site was chosen from among the electrode pair sites based on W-pattern in V1, R wave axis in inferior leads, and aVL/aVR relationship. After this site was marked on the 3D map, the catheter was removed and the pacing lead (Biotronik Solia S60) was advanced under 3D mapping guidance and deployed. Please see Table 1 for patient characteristics and procedure details. Please see figure for EAM Utilization of 3D mapping to select the ideal site of LBP capture can allow for (1) improved procedural efficiency, (2) decreased fluoroscopy usage, and (3) successful LBP capture with a single deployment.Tabled 1Patient characteristics and Procedure detailsPatient 1Patient 2Patient 3Age (years)645577GenderMaleMaleFemaleBody Mass Index (Kg/m2)273421Number of implant attempts111Fluoroscopy time2 minutes 25 secs1 min 47 secs2 minutes 50 secsComplicationsNoneNoneNone Open table in a new tab