{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:07:35Z","timestamp":1789578455688,"version":"build-2803163510"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,12,30]],"date-time":"2022-12-30T00:00:00Z","timestamp":1672358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,30]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Left bundle branch area pacing (LBBAP) can be technically challenging and fluoroscopy-intense. Three-dimensional electroanatomical mapping (EAM) facilitates non-fluoroscopic lead navigation and electrogram mapping. We sought to prospectively evaluate the feasibility, safety, and outcomes of routine EAM-guided LBBAP in patients with structural heart disease (SHD) and advanced conduction abnormalities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>Consecutive patients with SHD and conduction abnormalities who underwent an attempt at EAM-guided LBBAP were included. The feasibility, safety, procedural, and mid-term outcomes were evaluated. Electrical, echocardiographic, and clinical parameters were assessed at implantation and last follow-up. Thirty-two patients (68 \u00b1 18 years; 19% female) were included, of which 75% had intrinsic QRS &amp;gt; 150 ms, 53% left bundle branch block, and 25% right bundle branch block. Primary EAM-guided LBBAP was successful in 29 patients (91%). The procedural duration was 95 (70\u2013110) min, total fluoroscopy time 0.93 (0.40\u20131.73) min, and total fluoroscopy dose 35.4 (20.5\u201377.2) cGy cm2. Paced QRS duration (QRSd) was significantly shorter than intrinsic QRSd (121.9 \u00b1 10.7 vs. 159.2 \u00b1 34.4 ms; P &amp;lt; 0.001) and remained stable during the mean follow-up of 7.0 \u00b1 5.9 months. The LBBAP capture threshold was 0.57 \u00b1 0.23 V\/0.4 ms at implantation and remained low during follow-up (0.58 \u00b1 0.18 V\/0.5 \u00b1 0.2 ms; P = 0.877). Overall left ventricular ejection fraction improved significantly from 44.2 \u00b1 14.3% at baseline to 49.4 \u00b1 13.1% at follow-up (P = 0.009), New York Heart Association class from 2.4 \u00b1 0.6 to 1.8 \u00b1 0.6 (P = 0.002), respectively. No complications occurred that required intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Routine near-zero fluoroscopy EAM-guided LBBAP can safely be performed in patients with SHD and advanced conduction abnormalities with high success rates and favourable mid-term outcomes. Further studies are needed to investigate whether the use of EAM improves the overall outcome of conduction system pacing and to identify specific patient populations who benefit the most from EAM-guided lead implantation.<\/jats:p><\/jats:sec>","DOI":"10.1093\/europace\/euac232","type":"journal-article","created":{"date-parts":[[2022,12,30]],"date-time":"2022-12-30T02:09:45Z","timestamp":1672366185000},"page":"1068-1076","source":"Crossref","is-referenced-by-count":17,"title":["Electroanatomical mapping\u2013guided left bundle branch area pacing in patients with structural heart disease and advanced conduction abnormalities"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7128-6411","authenticated-orcid":false,"given":"Sergio","family":"Richter","sequence":"first","affiliation":[{"name":"Division of Electrophysiology, Heart Center Dresden, Technische Universit\u00e4t Dresden , Fetscherstr. 76, 01307 Dresden , Germany"},{"name":"Department of Electrophysiology, Heart Center, University of Leipzig , Str\u00fcmpellstr. 39, 04289 Leipzig , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Gebauer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Heart Center, University of Leipzig , Str\u00fcmpellstr. 39, 04289 Leipzig , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3480-5013","authenticated-orcid":false,"given":"Micaela","family":"Ebert","sequence":"additional","affiliation":[{"name":"Division of Electrophysiology, Heart Center Dresden, Technische Universit\u00e4t Dresden , Fetscherstr. 76, 01307 Dresden , Germany"},{"name":"Department of Electrophysiology, Heart Center, University of Leipzig , Str\u00fcmpellstr. 39, 04289 Leipzig , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cathleen","family":"Moscoso Ludue\u00f1a","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Heart Center, University of Leipzig , Str\u00fcmpellstr. 39, 04289 Leipzig , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Scheller","sequence":"additional","affiliation":[{"name":"Department of Therapy Specialists, Electrophysiology, Abbott Medical GmbH , Helfmann-Park 7, 65760 Eschborn , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Lucas","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Heart Center, University of Leipzig , Str\u00fcmpellstr. 39, 04289 Leipzig , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3759-3052","authenticated-orcid":false,"given":"Sebastian","family":"K\u00f6nig","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Heart Center, University of Leipzig , Str\u00fcmpellstr. 39, 04289 Leipzig , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3528-7174","authenticated-orcid":false,"given":"Ingo","family":"Paetsch","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Heart Center, University of Leipzig , Str\u00fcmpellstr. 39, 04289 Leipzig , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0132-0773","authenticated-orcid":false,"given":"Gerhard","family":"Hindricks","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Heart Center, University of Leipzig , Str\u00fcmpellstr. 39, 04289 Leipzig , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1372-3438","authenticated-orcid":false,"given":"Michael","family":"D\u00f6ring","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Heart Center, University of Leipzig , Str\u00fcmpellstr. 39, 04289 Leipzig , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,12,30]]},"reference":[{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1093\/europace\/euab232","article-title":"2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy","volume":"24","author":"Glikson","year":"2022","journal-title":"Europace"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jacep.2020.08.015","article-title":"Left bundle branch area pacing for cardiac resynchronization therapy: results from the international LBBAP collaborative study group","volume":"7","author":"Vijayaraman","year":"2021","journal-title":"JACC Clin Electrophysiol"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1016\/j.jacc.2009.06.006","article-title":"The effects of right ventricular apical pacing on ventricular function and dyssynchrony: implications for therapy","author":"Tops","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1136\/heartjnl-2018-313415","article-title":"Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block","volume":"105","author":"Huang","year":"2019","journal-title":"Heart"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"e006967","DOI":"10.1161\/CIRCEP.118.006967","article-title":"Low fluoroscopy permanent His bundle pacing using electroanatomic mapping: a feasibility study","volume":"12","author":"Sharma","year":"2019","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1093\/europace\/euaa292","article-title":"Impact of electroanatomical mapping-guided lead implantation on procedural outcome of His bundle pacing","volume":"23","author":"Richter","year":"2021","journal-title":"Europace"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"1984","DOI":"10.1111\/jce.14064","article-title":"His bundle pacing, learning curve, procedure characteristics, safety, and feasibility: insights from a large international observational study","volume":"30","author":"Keene","year":"2019","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.jacep.2020.04.011","article-title":"Cardiac resynchronization therapy in patients with nonischemic cardiomyopathy using left bundle branch pacing","volume":"6","author":"Huang","year":"2020","journal-title":"JACC Clin Electrophysiol"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.cjca.2020.04.037","article-title":"Left bundle branch pacing for cardiac resynchronization therapy: nonrandomized on-treatment comparison with His bundle pacing and biventricular pacing","volume":"37","author":"Wu","year":"2021","journal-title":"Can J Cardiol"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"3050","DOI":"10.1111\/jce.14242","article-title":"Left bundle branch pacing utilizing three dimensional mapping","volume":"30","author":"Vijayaraman","year":"2019","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"3195","DOI":"10.1111\/jce.15266","article-title":"Physiologic lead placement with electroanatomic mapping: a case series","volume":"32","author":"Baman","year":"2021","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1016\/j.hrthm.2019.06.016","article-title":"A beginner\u2019s guide to permanent left bundle branch pacing","volume":"16","author":"Huang","year":"2019","journal-title":"Heart Rhythm"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"172","DOI":"10.15420\/aer.2021.26","article-title":"ECG and pacing criteria for differentiating conduction system pacing from myocardial pacing","volume":"10","author":"Jastrz\u00eabski","year":"2021","journal-title":"Arrhythm Electrophysiol Rev"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.1161\/CIRCULATIONAHA.118.038648","article-title":"Intracardiac delineation of septal conduction in left bundle-branch block patterns","volume":"139","author":"Upadhyay","year":"2019","journal-title":"Circulation"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1007\/s00276-004-0302-7","article-title":"A macroscopic anatomical investigation of atrioventricular bundle locational variation relative to the membranous part of the ventricular septum in elderly human hearts","volume":"27","author":"Kawashima","year":"2005","journal-title":"Surg Radiol Anat"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.hrthm.2021.08.033","article-title":"Clinical outcomes of left bundle branch area pacing compared to right ventricular pacing: results from the Geisinger-Rush conduction system pacing registry","volume":"19","author":"Sharma","year":"2022","journal-title":"Heart Rhythm"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1016\/j.jacep.2020.07.004","article-title":"Initial experience, safety, and feasibility of left bundle branch area pacing: a multicenter prospective study","volume":"6","author":"Padala","year":"2020","journal-title":"JACC Clin Electrophysiol"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.ahj.2008.08.009","article-title":"Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: insights from the National Research Council\u2019s Biological Effects of Ionizing Radiation VII Report","volume":"157","author":"Venneri","year":"2009","journal-title":"Am Heart J"},{"key":"2023033021231670600_","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1093\/eurheartj\/ehz794","article-title":"Electroanatomical mapping-guided His bundle pacing in acquired dextroposition of the heart","volume":"41","author":"Richter","year":"2020","journal-title":"Eur Heart J"},{"key":"2023033021231670600_","first-page":"30088","article-title":"Permanent conduction system pacing for congenitally corrected transposition of the great arteries: a Pediatric and Congenital Electrophysiology Society (PACES)\/International Society for Adult Congenital Heart Disease (ISACHD) collaborative study","volume":"13","author":"Moore","year":"2020","journal-title":"Heart Rhythm"}],"container-title":["EP Europace"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/europace\/article-pdf\/25\/3\/1068\/49704082\/euac232.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/europace\/article-pdf\/25\/3\/1068\/49704082\/euac232.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T22:11:23Z","timestamp":1701468683000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/europace\/article\/25\/3\/1068\/6965364"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,30]]},"references-count":20,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,12,30]]},"published-print":{"date-parts":[[2023,3,30]]}},"URL":"https:\/\/doi.org\/10.1093\/europace\/euac232","relation":{},"ISSN":["1099-5129","1532-2092"],"issn-type":[{"value":"1099-5129","type":"print"},{"value":"1532-2092","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,3,1]]},"published":{"date-parts":[[2022,12,30]]}}}