Allied Professionals Community of Practice

  • 1.  LBBaP clinic follow up

    Posted 06-21-2024 12:04

    Hello,

    Our EP at our hospital has begun LBBaP implantation. I was curious what other clinics in country are doing for their clinic follow up? Is anyone going 12-lead routinely in clinic, running strip EKGs, high/low output pacing EKGs, bipolar/unipolar pacing EKGs? Has anyone changed frequency of follow up with this lead placement?

    Thank you for your time!

    Angie



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    Angela Anderson, RN, BSN
    Device Clinic Coordinator
    Altru Health System
    Grand Forks, North Dakota
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  • 2.  RE: LBBaP clinic follow up

    Posted 07-09-2024 05:16
    Edited by Mrs. Miriam Norman, MS, CCDS 07-09-2024 05:21

    I'm interested to hear what others are doing as well.

    My personal opinion, which I'm open to changing if convinced otherwise, is that it is not useful to routinely perform a 12-lead ECG at LBBAP follow-ups. Unless we are actually considering taking the patient back to theatre based on the results, it won't really add to anything to our management strategy.

    That said, it is useful to have a documented record of where the lead is, if there is "selective or non-selective capture", and what their usual surface ECG looks like. No need to do it every time though.

    We are sticking to the usual follow-up frequency.

    Regards,
    Miriam



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    Miriam Norman MS, CCDS
    Cardiac Physiologist
    Royal Hobart Hospital
    Hobart
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    Original Message


  • 3.  RE: LBBaP clinic follow up

    Posted 07-09-2024 14:22

    Our follow up for LBBA pacing leads is to do the 12 lead at the first 6week check.  The value of this is to discover if the lead is appropriately pacing the conduction system.  In some cases, our docs  will implant a back up lead if the pt is at risk for dislodgement, so if it does dislodge we can then program the LBB pacing lead off to maximize battery longevity.  Does not happen often, but it can happen. 

     

    Sallie Gustafson, RN, CCDS

    Sr Manager, Emory Cardiac Device Clinics

    404.778.4942

     




    Original Message


  • 4.  RE: LBBaP clinic follow up

    Posted 07-09-2024 10:36

    Hi Angie, 

        So we have a robust and yet simple protocol for our LBBaP patients.  I feel that without an EKG, it's not a true conduction system interrogation for the initial post implant check (post op and at first in office follow-up).  The TLDR version is - post implant we do EKG with whatever outputs set (bipolar) by the implanter.  we document LBBaP paced morphology and measure Stim-Peak (LV activation/RWave Peak time) in V5 or V6 and document it.  At their 1 month check, we repeat the EKG after chronic outputs are set (bipolar) and if no significant change in morphology or Stim-peak that's it.  Early on I treated these patients similar to HIS bundle patients and had their follow-ups set to have 12 lead rhythm strips in unipolar and bipolar configuration documenting threshold and changes with decrementing outputs (at 1, 3, 6, and 12monts), but found that it didn't change any thing long term and only led to unnecessarily long follow-up visits.  If there is ever an issue at the 1 month check, they come back at 3-6 months and I'll do the full gambit, but in the last 18 months I've only had to do this maybe three times.    

    When correctly placed, the LBBaP leads are very stable in my experience and don't require a lot of robust follow-up.  After their first in office visit, we see them generally once a year for an annual check and otherwise remotely monitor unless they need to come sooner.  

    Hopefully this helps!

    James



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    James O'Hara PhD, DrPH, DMSc, PA-C
    EP APP Lead
    Technical Director of Ambulatory Monitoring and Cardiovascular Implantable Electronic Devices (CIEDs).
    Cardiac Electrophysiology
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    Original Message


  • 5.  RE: LBBaP clinic follow up

    Posted 07-09-2024 14:28
    Hi everyone 

    Well, I will say that last week was the first time we had a LBBa pacing in my center. We did a 12 lead EKG on their first follow up and morphology was same.

    Thank you 



    Original Message


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