B-PO01-030 DEEP SEPTAL PACING WITH RAPID LEFT VENTRICULAR ACTIVATION: A SIMPLIFIED APPROACH WITHOUT CONDUCTION SYSTEM TARGETING

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Background

LV septal pacing results in comparable hemodynamics to left bundle, His bundle, or biventricular pacing.

Objective

We report the outcomes of a simplified method of septal pacing without conduction system targeting that results in rapid LV activation.

Methods

In 60 patients referred for pacing from 11/2019-11/2020, septal pacing was performed with a 3830 lead delivered via a reshaped C315 sheath (Medtronic, MN) to any site which allowed stability and a perpendicular orientation of the sheath tip to the right septum. The lead was advanced or repositioned until a paced QRS <140 ms was achieved. Implant success, complications, and electrophysiological parameters were assessed.

Results

Septal lead implantation was successful in 51/60 (85%). Mean age was 72±16 years, 18 were women, baseline QRS was 137±41 ms with 28% LBBB, 12% RBBB, and 15% RV paced. Pacing indications were atrioventricular block (47%), RV pacing induced cardiomyopathy (21%), refractory atrial fibrillation (18%) and cardiac resynchronization (14%). Procedural duration was 47 ± 28 minutes and fluoroscopy time was 15 ± 14 minutes with a mean of 2 ± 1.6 pacing sites trialed. Paced QRS was 117 ± 15 ms and

Conclusion

Deep septal pacing without conduction system targeting is safe, feasible, and results in rapid left ventricular activation.

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