Implant failures in conduction system pacing: single centre experience

Abstract Funding Acknowledgements Type of funding sources: None. Background Conduction system pacing (CSP) ensures physiological ventricular activation and avoids the dyssynchrony associated with traditional myocardial pacing. New dedicated tools makes it possible to increase procedural success but not yet comparable Objective Retrospective analysis 3-years CSP implants, focusing on implant failures. Methods From January 2019 June 2022, 639 were performed (91% PMs 9% ICDs). Single-chamber ICDs implants devices replacements excluded from because conduction could be an option in those cases. Pacing indications standard prevalence AV block (51%); AF slow rate 14.5%; sick sinus syndrome ablate&pace 4%; heart failure or cardiomyopathy 14.5%, re-interventions after malfunction a previous 1.5%. Mean age was 78±9 years; 62% males. Results successfully achieved 605 cases (94.6%). In 34 lead failed. Reasons for "anatomical" 15 (5 due excessive right atrial enlargement, 5 severe pulmonary hypertension; 3 scar septum 2 stenosis venous axis upgrading procedure) "technical" 19 unacceptable high thresholds, 10 uncorrected bundle branch block, 4 dislodgment during cutting without reposition). 52% failures, underlying documented. Considering failure, concluded biventricular 18 (in coronary implantation also failed) while 16 implanted apex. Conclusions is feasible daily clinical practice; available allow achieve (94.8% our experience). Procedural failures 5.2% caused by anatomical (44%) technical reason (56%).