Left bundle branch pacing (LBBP) is a physiological pacing technique that captures the left bundle branch (LBB) directly, causing the left ventricle (LV) to be excited earlier than the right ventricle (RV), resulting in a “iatrogenic” right bundle branch block (RBBB) pacing pattern. Several studies have recently shown that permanent LBBP can completely or partially narrow the wide QRS duration of the intrinsic RBBB in most patients with bradycardia, although the mechanisms by which this occurs has not been thoroughly investigated. This article presents a review of the LBBP in patients with intrinsic RBBB mentioned in current case reports and clinical studies, discussing the technique, possible mechanisms, future clinical explorations, and the feasibility of eliminating the interventricular dyssynchronization accompanied with LBBP.

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Background The novel method of left bundle branch pacing (LBBP) has been reported to achieve better electrical and mechanical synchrony in the left ventricle than conventional right ventricular pacing (RVP). However, its effects on right ventricle (RV) performance are still unknown. Methods Consecutive patients undergoing dual‐chamber pacemaker (PM) implantation for sick sinus syndrome (SSS) with normal cardiac function and a narrow QRS complex were recruited for the study. The pacing characteristics and echocardiogram parameters were measured to evaluate RV function, interventricular and RV synchrony, and were compared between ventricular pacing‐on and native‐conduction modes. Results A total of 84 patients diagnosed with SSS and an indication for pacing therapy were enrolled. Forty‐two patients (50%; mean age 65.50 ± 9.30 years; 35% male) underwent successful LBBP and 42 patients (50%; mean age 69.26 ± 10.08 years; 33% male) RVSP, respectively. Baseline characteristics were similar between the two groups. We found no significant differences in RV function [RV‐FAC (Fractional Area Change)%, 47.13 ± 5.69 versus 48.60 ± 5.83, p = .069; Endo‐GLS (Global Longitudinal Strain)%, −28.88 ± 4.94 versus −29.82 ± 5.35, p = .114; Myo‐GLS%, −25.72 ± 4.75 versus −25.72 ± 5.21, p = .559; Free Wall St%, 27.40 ± 8.03 versus −28.71 ± 7.34, p = .304] between the native‐conduction and LBBP capture modes, while the RVSP capture mode was associated with a significant reduction in the above parameters compared with the native‐conduction mode (p < .0001). The interventricular synchrony in the LBBP group was also superior to the RVSP group significantly. Conclusion LBBP is a pacing technique that seems to associate with a positive and protective impact on RV performance.

ObjectiveSelf-monitoring of blood glucose (SMBG) plays a vital role in the maintenance of blood glucose with type 2 diabetes mellitus(T2DM) and pre-diabetes patients. The study was intended to describe the current status of SMBG with T2DM and pre-diabetes patients in grassroots communities, explore the relationship between SMBG frequency and blood glucose level and apply information-motivation-behavior(IMB) model to analyze the potential influencing factors of SMBG compliance based on electronic questionnaires.MethodsA cross-sectional study was conducted with 1388 T2DM and pre-diabetes patients who completed electronic questionnaires composed of demographics and IMB model content. Chi-square test, Mann-Whitney U test and multivariable logistic regression model analysis were utilized to explore deeply causes of SMBG compliance.ResultsThe results of this study showed that among 1388 T2DM patients, only 26.2% (363/1388) patients reached SMBG standard, indicating low compliance with SMBG. Given that SMBG is one of the individual predictors of type 2 risk in prediabetes patients, this result suggests that the SMBG compliance rate needs to be improved. Patients with fixed occupation (OR=1.989, P=0.035), BMI in normal range (OR=1.336, P=0.049), smoking habit(OR=1.492, P=0.019), understanding SMBG frequency (OR=1.825, P&lt;0.001), understanding control goal of blood glucose (OR=1.414, P&lt;0.001), knowing all the functions of the blood glucose meter (OR=1.923, P&lt;0.001), buying a blood glucose meter/test paper conveniently(OR=2.329, P=0.047), taking supplementary measurement when forgetting blood glucose test(OR=2.044, P=0.005), rotating all the fingers when measuring blood glucose (OR=1.616, P&lt;0.001) and less pain at the needling site(OR=2.114, P&lt;0.001)were independently promoting factors of adherence to SMBG. However, the lack of accessibility and convenience of blood glucose meter or heavy financial burden were blocking factors of adherence to SMBG. Moreover, there were still bottlenecks such as lack of health care knowledge and needle pricking pain.ConclusionThis study verified the practicability of applying IMB model to SMBG with T2DM and pre-diabetes patients. Adherence to SMBG still remained to improved, and putting more emphasis in improvement of individual information, motivation and behavioral skills with patients might be beneficial to maintain better adherence to SMBG in long-term routine of diabetes self-management.