Electrical parameters, programming and acute complications
The acute electrical parameters obtained at implant are represented in
table 1. The mean QRS width in the entire cohort was significantly
reduced from 144±32 ms at baseline to 116±16 ms during HBP or LBBAP,
p=0.001 (Figure 4). The 5 patients with LVSP also significantly reduced
QRS width from 141±22 ms to 114±15 ms, p=0.029 (Figure 2). The average
penetration of the lead in the interventricular septum in the 5 patients
with LVSP evidenced by contrast through the sheath was 7.4±0.54 mm
(baseline mean interventricular septal thickness in these patients was
8.2±0.84 mm).
Patient #7 had a significant increase of LBB lead pacing threshold at
day 4 post-implant evidenced by the sudden appeareance of bradycardia on
remote monitoring. The initial implant procedure was challenging with
multiple attempts of fixation due to poor lead stability in complex
anatomy (D-TGA with Senning correction)(Figure 3). This patient
underwent repositioning of the lead in the same location with excellent
electrical parameters. A second back-up pacing lead was implanted in the
subpulmonic ventricle and connected to a CRT-P generator. No other acute
complications occurred in the study population.