Allied Professionals Community of Practice

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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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:
Sent: 7/9/2024 5:16:00 AM
From: Mrs. Miriam Norman, MS, CCDS
Subject: RE: LBBaP clinic follow up

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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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:
Sent: 7/9/2024 10:36:00 AM
From: Mr. James O'Hara, PhD, PA
Subject: RE: LBBaP clinic follow up

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

------------------------------
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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