Work

Multiple electrode leads facilitate left bundle branch area pacing: A concept evaluation study

Year: 2025

Type: article

Abstract: Background Left bundle branch area (LBBA) lead placement relies on single-electrode pacing guided by ECG markers during transeptal advancement. We hypothesize that multiple electrodes on a lead tip facilitate LBBA pacing. Objective Develop and evaluate a multi-electrode lead (MEL) with dimensions and electrical properties similar to clinically relevant lumenless leads (LLLs) for use in LBBA pacing. Methods Insulated 125μm silver wires were fixed along a 3D printed MEL shaft. Wires were wrapped circumferentially at distal, medial, and proximal sites (0.4mm apart), secured with polyimide, and de-insulated by sanding. The MEL tip was cut into a bevel shape to facilitate septal insertion. MEL has 5.4mm 2 surface area across the three electrodes, vs LLL's 3.6mm 2 surface area. MELs and LLLs were inserted at up to three LBBA sites in perfused canine hearts (n=4), totaling nine sites. Impedance, pacing threshold, and shortest QRS duration at each insertion site were recorded and compared. Results MEL and LLL had similar impedance and capture voltages. MEL's multiple pacing options evoked QRS morphology changes with pacing output and location. MEL more often detected a narrower QRS at insertion than LLL (LLL: 114ms, Q1-Q3: 98-120ms; MEL: 82ms, Q1-Q3: 68-98ms; p=0.03) and recorded QRS durations similar to sinus rhythm, suggesting MEL may better facilitate physiological pacing. Conclusion MELs more often evoked ECG markers indicative of conduction system capture during LBBA pacing, suggesting MELs may streamline implantation, reduce lead repositioning, and advance conduction system pacing strategies.

Source: Heart Rhythm O2

DOI: 10.1016/j.hroo.2025.04.012