BACKGROUND: The clinical impact of Periprocedural myocardial injury (PMI) in patients undergoing permanent pacemaker implantation with Left Bundle Branch Area Pacing (LBBAP) is unknown. METHODS: 130 patients undergoing LBBAP from January 2020 to June 2021 and completing 12 months follow up were enrolled to assess the impact of PMI on composite clinical outcome (CCO) defined as any of the following: all-cause death, hospitalization for heart failure (HHF), hospitalization for acute coronary syndrome (ACS) and ventricular arrhythmias (VAs). High sensitivity Troponin T (HsTnT) was measured up to 24-h after intervention to identify the peak HsTnT values. PMI was defined as increased peak HsTnT values at least > 99th percentile of the upper reference limit (URL: 15 pg/ml) in patients with normal baseline values. RESULTS: PMI occurred in 72 of 130 patients (55%). ROC analysis yielded a post-procedural peak HsTnT cutoff of fourfold the URL for predicting the CCO (AUC: 0.692; p = 0.023; sensitivity 73% and specificity 71%). Of the enrolled patients, 20% (n = 26) had peak HsTnT > fourfold the URL. Patients with peak HsTnT > fourfold the URL exhibited a higher incidence of the CCO than patients with peak HsTnT ≤ fourfold the URL (31% vs. 10%; p = 0.005), driven by more frequent hospitalizations for ACS (15% vs. 3%; p = 0.010). Multiple (> 2) lead repositions attempts, the use of septography and stylet-driven leads were independent predictors of higher risk of PMI with peak HsTnT > fourfold the URL. CONCLUSIONS: PMI seems common among patients undergoing LBBAP and may be associated with an increased risk of clinical outcomes in case of more pronounced (peak HsTnT > fourfold the URL) myocardial damage occurring during the procedure.

1st Department of Internal Medicine Cardiology and Angiology Faculty of Medicine University Hospital and Charles University Hradec Králové Czech Republic

Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares Madrid Spain

Department of Cardiology Cardiocenter 3rd Faculty of Medicine Charles University University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Cardiology Cardiovascular Research Institute Maastricht Maastricht University Medical Center Maastricht The Netherlands

Department of Cardiovascular Sciences Policlinico Casilino of Rome Via Casilina 1049 00169 Rome Italy

Electrophysiology Section Cardiology Department Hospital Universitari 1 Politècnic La Fe Área de Enfermedades Cardiovasculares Valencia Spain

Pauley Heart Center Division of Cardiology Department of Internal Medicine Virginia Commonwealth University Richmond VA USA

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McEvoy JW, Daya N, Tang O, Fang M, Ndumele CE, Coresh J, et al. High-sensitivity troponins and mortality in the general population. Eur Heart J. 2023;44(28):2595–605. PubMed DOI PMC

Wereski R, Adamson P, ShekDaud NS, McDermott M, Taggart C, Bularga A, et al. High-sensitivity cardiac troponin for risk assessment in patients with chronic coronary artery disease. J Am Coll Cardiol. 2023;82(6):473–85. PubMed DOI

Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J. 2022;43(39):3826–924. PubMed DOI

Vijayaraman P, Chelu MG, Curila K, Dandamudi G, Herweg B, Mori S, Jastrzebski M, Sharma PS, Shivkumar K, Tung R, Upadhyay G, Vernooy K, Welter-Frost A, Whinnett Z, Zanon F, Ellenbogen KA. Cardiac conduction system pacing: A comprehensive update. JACC Clin Electrophysiol. 2023 Nov;9(11):2358–2387.

Keene D, Anselme F, Burri H, Pérez ÓC, Čurila K, Derndorfer M, Foley P, Gellér L, Glikson M, Huybrechts W, Jastrzebski M, Kaczmarek K, Katsouras G, Lyne J, Verdú PP, Restle C, Richter S, Timmer S, Vernooy K, Whinnett Z. Conduction system pacing, a European survey: insights from clinical practice. Europace. 2023 May 19;25(5):euad019.

Chung MK, Patton KK, Lau CP, Dal Forno ARJ, Al-Khatib SM, Arora V, Birgersdotter-Green UM, Cha YM, Chung EH, Cronin EM, Curtis AB, Cygankiewicz I, Dandamudi G, Dubin AM, Ensch DP, Glotzer TV, Gold MR, Goldberger ZD, Gopinathannair R, Gorodeski EZ, Gutierrez A, Guzman JC, Huang W, Imrey PB, Indik JH, Karim S, Karpawich PP, Khaykin Y, Kiehl EL, Kron J, Kutyifa V, Link MS, Marine JE, Mullens W, Park SJ, Parkash R, Patete MF, Pathak RK, Perona CA, Rickard J, Schoenfeld MH, Seow SC, Shen WK, Shoda M, Singh JP, Slotwiner DJ,Sridhar ARM, Srivatsa UN, Stecker EC, Tanawuttiwat T, Tang WHW, Tapias CA, Tracy CM, Upadhyay GA, Varma N, Vernooy K, Vijayaraman P, Worsnick SA, Zareba W, Zeitler EP. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. Heart Rhythm. 2023 Sep;20(9):e17–e91.

Burri H, Jastrzebski M, Cano Ó, Čurila K, de Pooter J, Huang W, et al. EHRA clinical consensus statement on conduction system pacing implantation: endorsed by the Asia Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS), and Latin American Heart Rhythm Society (LAHRS). Europace. 2023;25(4):1208–36. PubMed DOI PMC

Burri H. Complications with left bundle branch area pacing. Heart Rhythm. 2022;19(5):735–6. PubMed DOI

Trivedi R, Rattigan E, Bauch TD, Mascarenhas V, Ahmad T, Subzposh FA, et al. Giant interventricular septal hematoma complicating left bundle branch pacing: a cautionary tale. JACC Case Rep. 2023;16:101887. PubMed DOI PMC

Palmisano P, Dell'Era G, Guerra F, Ammendola E, Ziacchi M, Laffi M, Donateo P, Guido A, Ghiglieno C, Parlavecchio A, Dello Russo A, Nigro G, Biffi M, Gaggioli G, Senes J, Patti G, Accogli M, Coluccia G. Complications of left bundle branch area pacing compared with biventricular pacing in candidates for resynchronization therapy: Results of a propensity score-matched analysis from a multicenter registry. Heart Rhythm. 2024 Jun;21(6):874–880.

Ponnusamy SS, Patel NR, Naperkowski A, Subzposh FA, Vijayaraman P. Cardiac troponin release following left bundle branch pacing. J Cardiovasc Electrophysiol. 2021;32(3):851–5. PubMed DOI

Ferrari ADL, Klafke LH, Soccol R, Abelin AP, Piantá RM, Caramori PRA, Chemello D. Coronary artery complications after left bundle branch area pacing: An increasingly reported issue in the era of physiologic pacing. Pacing Clin Electrophysiol. 2024 Jan;47(1):101–105.

Ponnusamy SS, Vijayaraman P. Aborted ST-elevation myocardial infarction-An unusual complication of left bundle branch pacing. HeartRhythm Case Rep. 2020;6(8):520–2. PubMed DOI PMC

Huang W, Chen X, Su L, Wu S, Xia X, Vijayaraman P. A beginner’s guide to permanent left bundle branch pacing. Heart Rhythm. 2019;16(12):1791–6. PubMed DOI

Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2018;40(3):237–69. DOI

Jaffe AS, Body R, Mills NL, Aakre KM, Collinson PO, Saenger A, et al. Single troponin measurement to rule out myocardial infarction: JACC review topic of the week. J Am Coll Cardiol. 2023;82(1):60–9. PubMed DOI

Taggart C, Monterrubio-Gómez K, Roos A, Boeddinghaus J, Kimenai DM, Kadesjo E, et al. Improving Risk Stratification for Patients With Type 2 Myocardial Infarction. J Am Coll Cardiol. 2023;81(2):156–68. PubMed DOI PMC

Martignani C, Diemberger I, Biffi M, Ziacchi M, Saporito D, Valzania C, et al. Troponin I rise after pacemaker implantation at the time of “universal definition of myocardial infarction.” Am J Cardiol. 2009;103(8):1061–5. PubMed DOI

Varvarousis D, Goulas N, Polytarchou K, Psychari SN, Paravolidakis K, Konstantinidou A, et al. Biomarkers of myocardial injury and inflammation after permanent pacemaker implantation: the lead fixation type effect. J Atr Fibrillation. 2018;10(6):1798. PubMed DOI PMC

Altin T, Akyurek O, Vurgun K, Beton O, Sayin T, Kilickap M, et al. Effect of transvenous cardiac resynchronization therapy device implantation on cardiac troponin I release. Pacing Clin Electrophysiol. 2007;30(11):1356–62. PubMed DOI

Castellanos DA, Carreon CK, Prakash A, Sanders SP, Lee G, Eildermann K, et al. Pacemaker lead insertion sites contribute to abnormalities of myocardial function and histopathology. Heart Rhythm. 2023;20(12):1739–49. PubMed DOI

Cabrera J-Á, Porta-Sánchez A, Tung R, Sánchez-Quintana D. Tracking down the anatomy of the left bundle branch to optimize left bundle branch pacing. JACC: Case Rep. 2020;2(5):750–5.

Diaz JC, Sauer WH, Duque M, Koplan BA, Braunstein ED, Marín JE, Aristizabal J, Niño CD, Bastidas O, Martinez JM, Hoyos C, Matos CD, Lopez-Cabanillas N, Steiger NA, Kapur S, Tadros TM, Martin DT, Zei PC, Tedrow UB, Romero JE. Left bundle branch area pacing versus biventricular pacing as initial strategy for cardiac resynchronization. JACC Clin Electrophysiol. 2023 Aug;9(8 Pt 2):1568–1581.

Vijayaraman P, Sharma PS, Cano Ó, Ponnusamy SS, Herweg B, Zanon F, et al. Comparison of left bundle branch area pacing and biventricular pacing in candidates for resynchronization therapy. J Am Coll Cardiol. 2023;82(3):228–41. PubMed DOI

Ponnusamy SS, Basil W, Vijayaraman P. Electrophysiological characteristics of septal perforation during left bundle branch pacing. Heart Rhythm. 2022;19(5):728–34. PubMed DOI

Mizner J, Jurak P, Linkova H, Smisek R, Curila K. Ventricular dyssynchrony and pacing-induced cardiomyopathy in patients with pacemakers, the utility of ultra-high-frequency ECG and other dyssynchrony assessment tools. Arrhythm Electrophysiol Rev. 2022;11: e17. PubMed DOI PMC

Shen J, Jiang L, Wu H, Li H, Zhong J, Pan L. Case report: Left bundle branch pacing guided by real-time monitoring of current of injury and electrocardiography. Front Cardiovasc Med. 2022;9:1025620. PubMed DOI PMC

Liu X, Niu HX, Gu M, Chen X, Hu Y, Cai M, et al. Contrast-enhanced image-guided lead deployment for left bundle branch pacing. Heart Rhythm. 2021;18(8):1318–25. PubMed DOI

Batul SA, Mahajan A, Subzposh FA, Young W, Mathew A, Pokharel P, et al. Coronary venous visualization during deep septal lead placement: an unexpected finding. JACC Case Rep. 2022;4(24):101622. PubMed DOI PMC

Pujol-López M, Ferró E, Borràs R, Garre P, Guasch E, Jiménez-Arjona R, Garcia-Ribas C, Doltra A, Niebla M, Carro E, Roca-Luque I, Guichard JB, Puente JL, Uribe L, Vázquez-Calvo S, Castel MÁ, Arbelo E, Porta-Sánchez A, Sitges M, Tolosana JM, Mont L. Stepwise application of ECG and electrogram-based criteria to ensure electrical resynchronization with left bundle branch pacing. Europace. 2023 Jun 2;25(6):euad128.

Jastrzębski M, Kiełbasa G, Curila K, Moskal P, Bednarek A, Rajzer M, et al. Physiology-based electrocardiographic criteria for left bundle branch capture. Heart Rhythm. 2021;18(6):935–43. PubMed DOI

Briongos-Figuero S, Estévez-Paniagua Á, Sánchez-Hernández A, Muñoz-Aguilera R. Combination of current and new electrocardiographic-based criteria: a novel score for the discrimination of left bundle branch capture. Europace. 2023;25(3):1051–9. PubMed DOI PMC

De Pooter J, Ozpak E, Calle S, Peytchev P, Heggermont W, Marchandise S, et al. Initial experience of left bundle branch area pacing using stylet-driven pacing leads: A multicenter study. J Cardiovasc Electrophysiol. 2022;33(7):1540–9. PubMed DOI

Jastrzębski M, Kiełbasa G, Cano O, Curila K, Heckman L, De Pooter J, et al. Left bundle branch area pacing outcomes: the multicentre European MELOS study. Eur Heart J. 2022;43(40):4161–73. PubMed DOI PMC

Tan ESJ, Lee JY, Boey E, Soh R, Sim MG, Yeo WT, et al. Use of extendable helix leads for conduction system pacing: differences in lead handling and performance lead design impacts conduction system pacing. J Cardiovasc Electrophysiol. 2022;33(7):1550–7. PubMed DOI

De Pooter J, Wauters A, Van Heuverswyn F, Le Polain de Waroux JB. A guide to left bundle branch area pacing using stylet-driven pacing leads. Front Cardiovasc Med. 2022;9:844152.

Özpak E, Van Heuverswyn F, Timmermans F, De Pooter J. Lead performance of stylet-driven leads in left bundle branch area pacing: Results from a large single-center cohort and insights from in vitro bench testing. Heart Rhythm. 2024 Jun;21(6):865–873.

Cano Ó, Navarrete-Navarro J, Zalavadia D, Jover P, Osca J, Bahadur R, et al. Acute performance of stylet driven leads for left bundle branch area pacing: A comparison with lumenless leads. Heart Rhythm O2. 2023;4(12):765–76.

Perino AC, Wang PJ, Lloyd M, Zanon F, Fujiu K, Osman F, Briongos-Figuero S, Sato T, Aksu T, Jastrzebski M, Sideris S, Rao P, Boczar K, Yuan-Ning X, Wu M, Namboodiri N, Garcia R, Kataria V, De Pooter J, Przibille O, Gehi AK, Cano O, Katsouras G, Cai B, Astheimer K, Tanawuttiwat T, Datino T, Rizkallah J, Alasti M, Feld G, Barrio-Lopez MT, Gilmore M, Conti S, Yanagisawa S, Indik JH, Zou J, Saha SA, Rodriguez-Munoz D, Chang KC, Lebedev DS, Leal MA, Haeberlin A, Forno ARJD, Orlov M, Frutos M, Cabanas-Grandio P, Lyne J, Leyva F, Tolosana JM, Ollitrault P, Vergara P, Balla C, Devabhaktuni SR, Forleo G, Letsas KP, Verma A, Moak JP, Shelke AB, Curila K, Cronin EM, Futyma P, Wan EY, Lazzerini PE, Bisbal F, Casella M, Turitto G, Rosenthal L, Bunch TJ, Baszko A, Clementy N, Cha YM, Chen HC, Galand V, Schaller R, Jarman JWE, Harada M, Wei Y, Kusano K, Schmidt C, Hurtado MAA, Naksuk N, Hoshiyama T, Kancharla K, Iida Y, Mizobuchi M, Morin DP, Cay S, Paglino G, Dahme T, Agarwal S, Vijayaraman P, Sharma PS. Worldwide survey on implantation of and outcomes for conduction system pacing with His bundle and left bundle branch area pacing leads. J Interv Card Electrophysiol. 2023 Oct;66(7):1589–1600.