Radiofrequency current-facilitated implantation of left bundle branch pacing lead for cardiac resynchronization therapy

BACKGROUND: Fibrosis within the interventricular septum hinders the implantation of left bundle branch pacing (LBBP) lead, particularly in candidates for cardiac resynchronization therapy (CRT). OBJECTIVE: This study aimed to report the acute and follow-up outcomes of pacing lead implantation using radiofrequency (RF) current delivered to the lead tip for septal electrosection in challenging LBBP cases. METHODS: Data on lead deployment success, RF power and delivery time, complications, lead stability, proarrhythmia, current of injury, and pacing parameters were collected acutely and at the final follow-up. RESULTS: A total of 37 RF-facilitated lead implantations in 36 patients (average age 71.6 ± 8.8 years), most of whom were CRT eligible (89%), were analyzed. On average, 2.1 ± 1.7 RF applications (resulting in 2.6 ± 2.2 seconds of RF) were used per implantation with a median power of 27 W. RF delivery was used in 85.7% of cases to achieve a current of injury drop that could not be obtained with manual lead rotation alone. Lead implantation was successful in all but 2 cases. The mean follow-up duration was 236 ± 165 days. Lead performance, including pacing parameters and lead stability, was good and did not seem to be affected by RF use (follow-up threshold 0.8 ± 0.3 V; sensitivity: 12.0 ± 5.6 mV). 1 patient experienced sustained ventricular tachycardia, and in all other cases, proarrhythmia was absent or self-limited. No other complications were noted. CONCLUSION: RF-facilitated LBBP lead implantation is a feasible technique with potential cautious use as a bailout in selected cases, especially for failed CRT delivery.