Search

The article discusses left bundle branch area pacing (LBBAP) as a preferred pacing strategy to preserve ventricular synchrony and minimize the risk of pacing-induced cardiomyopathy. LBBAP has several benefits, including improved clinical outcomes in heart failure patients with left bundle branch block (LBBB) and lower risk for heart failure hospitalization compared to traditional cardiac resynchronization therapy (CRT). However, there are challenges to successful LBBAP implantation, such as difficulty targeting the proper zone on the interventricular septum and navigating in a dilated heart. Right-sided implantations also present anatomical and technical challenges. A study presented in the article found that right-sided implantation of LBBAP was feasible and safe, but it required longer fluoroscopy time and more frequent delivery system exchanges compared to left-sided implantation. Further studies are needed to track the clinical outcomes of right-sided LBBAP implants. [Extracted from the article]

Purpose: Accessory pathway (AP) mapping is currently based on point-by-point mapping and identifying if a local electrogram's origin is atrial, pathway, or ventricular, which is time-consuming and prone to insufficient mapping. We sought to determine the feasibility of automated and high-density mapping to define AP location using open-window mapping (OWM), which does not rely on defining the electrogram's origin but simply detects the sharpest local signal at each point. Methods: We enrolled 23 consecutive patients undergoing catheter ablation for atrioventricular reentrant tachycardia. High-density mapping was performed using OWM and ablation was performed. The successful site of ablation was determined by the loss of pathway function. Results: OWM was 100% effective at identifying the successful site of ablation (average mapping time 7.3 ± 4.3 min.) Permanent AP elimination was achieved using a mean radiofrequency energy time of 18.5 ± 24.5 s/patient. Transiently successful ablations were 4.0 ± 1.8 mm from permanently successful sites and had lower contact force (5.1 ± 2.5 g vs. 11.7 ± 9.0 g; P = 0.041). Unsuccessful sites had similar contact force to permanently successful sites (12.2 ± 9.2 g vs. 11.7 ± 9.0 g; P = 0.856) but were 6.4 ± 2.0 mm away from successful sites. Conclusion: A novel technique of high-density, automated, and open-window mapping (OWM) effectively localizes APs without the need to differentiate the signal's site of origin. These findings suggest that OWM can be used to rapidly and successfully map and ablate APs. Both distances from the pathway and contact force were shown to be important for pathway ablation. [ABSTRACT FROM AUTHOR]