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Peer-reviewedCC BYDiagnostics (Basel, Switzerland)

Transthoracic Echocardiography-Assisted, Low-Fluoroscopy Left Bundle Branch Area Pacing: A Comparison of Implantation Approaches and Lead Types.

  • Po-Hua Chu1,2
  • Chung-Lieh Hung1,3
  • Kuo-Tzu Sung1,4,5
  • Shu-Fen Hsu5,6
  • Cheng-Ting Tsai1,2
  • Jen-Yuan Kuo1,2
  • Sheng-Hsiung Chang1,2
6 affiliations
  1. 1Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104217, Taiwan.
  2. 2Department of Nursing, MacKay Junior College of Medicine, Nursing, and Management, New Taipei City 252005, Taiwan.
  3. 3Institute of Biomedical Sciences, MacKay Medical University, New Taipei City 252005, Taiwan.
  4. 4Department of Medicine, MacKay Medical University, New Taipei City 252005, Taiwan.
  5. 5Department of Telehealth, MacKay Memorial Hospital, Taipei 104217, Taiwan.
  6. 6School of Nursing, MacKay Medical University, Taipei 252005, Taiwan.
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Abstract

Background: Transthoracic echocardiography (TTE)-assisted left bundle branch area pacing (LBBAP) is a potential supplementary to fluoroscopy-guided implantation and may reduce radiation. Objectives: To evaluate the feasibility and long-term stability of TTE-assisted, low-fluoroscopy LBBAP across different workflows and lead types. Methods: This retrospective study enrolled 45 consecutive patients between November 2021 and June 2022, analyzing 42 successful cases. Patients were stratified by workflow approach (non-scrubbed, n = 24; scrubbed aseptic, n = 18) and lead type (lumen-less leads [LLLs], n = 20; stylet-driven leads [SDLs], n = 22). Procedural and pacing parameters were assessed through a 4-year follow-up. Results: In select patients with adequate acoustic windows, multi-stage TTE-assisted LBBAP remained feasible despite a 54.8% overweight/obesity rate. The scrubbed aseptic workflow showed significantly shorter procedural and fluoroscopy times (p < 0.01), though confounded by the learning curve. Beyond 6 months, pacing parameters remained stable and comparable between workflows through 4 years. Regarding lead types, procedural durations were similar. However, the SDL group exhibited significantly higher pacing thresholds at implant and 6 months (p < 0.05) and maintained a higher numerical trend through Year 4, though both lead types demonstrated stable chronic sensing and impedance profiles. No late dislodgements, device-related infections, or late complications occurred across available patient-years. Conclusions: TTE-assisted LBBAP is a clinically feasible approach that can supplement conventional implantation in selected patients with favorable acoustic windows. While achieving excellent 4-year functional durability, procedural improvements reflect the combined effect of workflow refinement and operator proficiency.

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Cite

BibTeXRIS
BibTeX
@article{chu2026transthoracic,
  title = {{Transthoracic Echocardiography-Assisted, Low-Fluoroscopy Left Bundle Branch Area Pacing: A Comparison of Implantation Approaches and Lead Types.}},
  author = {Po-Hua Chu and Chung-Lieh Hung and Kuo-Tzu Sung and Shu-Fen Hsu and Cheng-Ting Tsai and Jen-Yuan Kuo and Sheng-Hsiung Chang},
  journal = {Diagnostics (Basel, Switzerland)},
  year = {2026},
  month = sep,
  doi = {10.3390/diagnostics16193172},
  url = {https://europepmc.org/article/MED/42882327},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Transthoracic Echocardiography-Assisted, Low-Fluoroscopy Left Bundle Branch Area Pacing: A Comparison of Implantation Approaches and Lead Types.
AU  - Po-Hua Chu
AU  - Chung-Lieh Hung
AU  - Kuo-Tzu Sung
AU  - Shu-Fen Hsu
AU  - Cheng-Ting Tsai
AU  - Jen-Yuan Kuo
AU  - Sheng-Hsiung Chang
PY  - 2026
DA  - 2026/09/29
JO  - Diagnostics (Basel, Switzerland)
DO  - 10.3390/diagnostics16193172
UR  - https://europepmc.org/article/MED/42882327
AB  - Background: Transthoracic echocardiography (TTE)-assisted left bundle branch area pacing (LBBAP) is a potential supplementary to fluoroscopy-guided implantation and may reduce radiation. Objectives: To evaluate the feasibility and long-term stability of TTE-assisted, low-fluoroscopy LBBAP across different workflows and lead types. Methods: This retrospective study enrolled 45 consecutive patients between November 2021 and June 2022, analyzing 42 successful cases. Patients were stratified by workflow approach (non-scrubbed, n = 24; scrubbed aseptic, n = 18) and lead type (lumen-less leads [LLLs], n = 20; stylet-driven leads [SDLs], n = 22). Procedural and pacing parameters were assessed through a 4-year follow-up. Results: In select patients with adequate acoustic windows, multi-stage TTE-assisted LBBAP remained feasible despite a 54.8% overweight/obesity rate. The scrubbed aseptic workflow showed significantly shorter procedural and fluoroscopy times (p < 0.01), though confounded by the learning curve. Beyond 6 months, pacing parameters remained stable and comparable between workflows through 4 years. Regarding lead types, procedural durations were similar. However, the SDL group exhibited significantly higher pacing thresholds at implant and 6 months (p < 0.05) and maintained a higher numerical trend through Year 4, though both lead types demonstrated stable chronic sensing and impedance profiles. No late dislodgements, device-related infections, or late complications occurred across available patient-years. Conclusions: TTE-assisted LBBAP is a clinically feasible approach that can supplement conventional implantation in selected patients with favorable acoustic windows. While achieving excellent 4-year functional durability, procedural improvements reflect the combined effect of workflow refinement and operator proficiency.
SN  - 2075-4418
ER  -