Technical feasibility of leadless left bundle branch area pacing for cardiac resynchronisation: a case series

Background Left bundle branch area pacing (LBBAP) is a novel form of conduction system pacing which can reverse left bundle branch block and deliver cardiac resynchronisation therapy (CRT). The WiSE-CRT system delivers leadless endocardial pacing with symptomatic and left ventricular (LV) remodelling improvements following intervention. We report the technical feasibility of delivering leadless LBBAP using the WiSE-CRT system. Case Summary In case 1, a 57-year-old male with ischaemic cardiomyopathy and complete heart block underwent implantation of the WiSE-CRT system, using a retrograde trans-aortic approach, after failed conventional CRT. Temporary left bundle stimulation from the LV septum achieved superior electrical resynchronisation and equivalent haemodynamic response compared to endocardial pacing at the lateral LV wall. In case 2, an 82-year-old gentleman with tachyarrhythmia-induced cardiomyopathy underwent WiSE-CRT implantation via a trans-septal intra-atrial approach, with the endocardial electrode successfully deployed in the LV septum. Discussion Here we report the first case of deployment of the WiSE-CRT endocardial electrode in the LV septum, and demonstrate the technical feasibility of leadless LBBAP. Entirely leadless CRT is an attractive option for patients with venous access issues or recurrent lead complications and has previously been successful using the WiSE-CRT system and a leadless pacemaker in the right ventricle. Further studies are required to assess long-term efficacy and safety of leadless LBBAP.

Temporary transvenous endocardial pacing: method of endocardial electrode reposition in the right ventricular cavity of the heart

Aim. To justify and develop method of endocardial electrode reposition in the right ventricular cavity of the heart in the spontaneous termination of temporary pacing in patients with recurrent myocardial infarction.Methods. A method of endocardial electrode reposition was used in 23 patients with myocardial infarction complicated by acute bradyarrhythmias. Written informed consent was obtained from all patients, and in the absence of contact with the patient, decision to insert temporary artificial pacemaker was made by medical consultation.Results. A method of endocardial electrode reposition that provides threading the electrode from the venous bed to the right ventricular cavity of the heart, cardiac stimulation by electrical impulses and creation the new contacts between electrode and right ventricular endocardium of the heart using the same electrode, both in the presence and in absence of the heart conduction and excitation function, was developed. At the same time, it excludes the electrode dislocation from the right ventricular cavity of the heart, provides the electrode fixation with endocardium, and at the same time allows to impose a stable artificial heart rhythm in the shortest time. During the spontaneous termination of the effective artificial pacemaker, endocardial electrodes reposition enabled to promptly regain the heart rhythm control in all 23 patients with acute bradyarrhythmia of infarction genesis.Conclusion. Effective and safe method of endocardial electrode reposition in the right ventricular cavity of the heart in the spontaneous termination of temporary pacing in patients with recurrent myocardial infarction was developed and introduced into clinical practice.

Experience of the original endocardial electrode use for temporary pacing of cardiac function

Aim. To assess the effectiveness of the original puncture transvenous temporary endocardial springy electrode use in patients with myocardial infarction complicated by bradyarrhythmias.Methods. The study included 126 patients with myocardial infarction complicated by acute bradyarrhythmias. The original endocardial electrode was used in 38 patients (main group). Temporary artificial heart rhythm control was performed using endocardial springy temporary puncture electrode in 88 cases of bradyarrhythmias (control group). Written informed consent was taken from all patients who underwent the procedure, and in the absence of contact with the patient decision to perform temporary cardiac pacing was made by a council of physicians.Results.. Spontaneous pacing interruption occurred in 13 patients of the main group and 32 control group patients at various times of the artificial pacing. Thanks to the used original electrode constructional features, fatal cases were prevented in 11 (84.6%) patients of the main group. In 9 of 32 patients of the control group with impaired pacemaker, cardiac pacing was restored by the electrode re-fixation to the heart right ventricular endocardium. In 23 patients of the control group artificial rhythm was restored by the method of endocardial electrode reposition. The number of patients with a spontaneous interruption of temporary artificial heart rhythm control had a strong correlation with the number of patients with the identified new changes in the electrocardiogram (ST segment elevation with acute recurrent myocardial infarction; r=0.84, pConclusion. In case of spontaneous interruption of temporary cardiac pacing caused by the loss of myocardial electrical conduction function in the area of the contact with the electrode, for effective and safe fatal cases prevention endocardial electrodes of the original design use is recommended.