Cardiac Conduction System Pacing

Vijayaraman, Pugazhendhi; Chelu, Mihail G.; Čurila, Karol; Dandamudi, Gopi; Herweg, Bengt; Mori, Shigeo; Jastrzębski, Marek; Sharma, Parikshit S.; Shivkumar, Kalyanam; Tung, Roderick; Upadhyay, Gaurav A.; Vernooy, Kevin; Welter-Frost, Allan; Whinnett, Zachary I.; Zanon, Francesco; Ellenbogen, Kenneth A.

doi:10.1016/j.jacep.2023.06.005

Cited by 15 publications

(6 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…LBBAP was performed using previously described methods. 7 Final position of the LBBAP lead was considered successful if the unipolar paced QRS morphology demonstrated a Qr or qR pattern in V 1 along with any of the following: (1) recording of left bundle branch potential, (2) demonstration of transition from nonselective to selective left bundle branch/left ventricular (LV) septal capture during threshold testing, or (3) R-wave peak time in leads V 5 through V 6 <90 ms. In some patients, an LV lead was also implanted in a coronary venous branch at the operator's discretion to achieve LBBAP-optimized CRT (LOT-CRT) or to be available as a back-up lead.…”

Section: Methodsmentioning

confidence: 99%

“…This observation is likely explained by the more complete resynchronization by LBBAP reported previously. 7 Furthermore, conduction system pacing may be associated with improved diastolic function compared with BVP. 43 More physiological LBBAP may result in decreased left atrial pressure and reverse atrial remodeling.…”

Section: Proarrhythmia Encountered In Patients With Bvpmentioning

confidence: 99%

See 1 more Smart Citation

Arrhythmic Risk in Biventricular Pacing Compared With Left Bundle Branch Area Pacing: Results From the I-CLAS Study

Herweg,

Sharma,

Cano

et al. 2024

Circulation

Self Cite

View full text Add to dashboard Cite

Background: Left bundle branch area pacing (LBBAP) may be associated with greater improvement in left ventricular ejection fraction and reduction in death or heart failure hospitalization when compared with biventricular pacing (BVP) in patients requiring cardiac resynchronization therapy (CRT). We sought to compare the occurrence of sustained ventricular tachycardia or ventricular fibrillation (VT/VF) and new onset atrial fibrillation (AF) in patients undergoing BVP and LBBAP. Methods: This International Collaborative LBBAP Study (I-CLAS) included patients with LVEF≤35% who underwent BVP or LBBAP for CRT between Jan 2018 to June 2022 at 15 centers. We performed propensity score matched (PS) analysis of LBBAP and BVP in a 1:1 ratio. We assessed the incidence of VT/VF and new-onset AF among patients with no prior history of AF. Time to sustained VT/VF and time to new-onset AF was analyzed using Cox proportional hazards survival model. Results: Among 1778 patients undergoing CRT (981-BVP, 797-LBBAP), PS matched 1414 patients (PS-BVP:707, PS-LBBAP:707). The occurrence of VT/VF was significantly lower with LBBAP compared with BVP (4.2% vs 9.3%;HR 0.46;95%CI 0.29-0.74;p<0.001). The incidence of VT storm (>3 episodes in 24 hours) was also significantly lower with LBBAP compared with BVP (0.8% vs 2.5%;p=0.013). Among 299 patients with CRT-pacemakers (BVP-111, LBBAP-188), VT/VF occurred in 8 patients in the BVP group vs. none in the LBBAP group (7.2% vs 0%;p<0.001). In 1194 patients with no prior history of VT/VF or antiarrhythmic therapy (BVP-591, LBBAP-603), the occurrence of VT/VF was significantly lower with LBBAP compared with BVP (3.2% vs 7.3%;HR 0.46;95%CI 0.26-0.81;p=0.007). Among patients with no prior history of AF (n=890), the occurrence of new-onset AF >30 seconds was significantly lower with LBBAP compared with BVP (2.8% vs 6.6%;HR 0.34;95%CI 0.16-0.73;p=0.008). The incidence of AF lasting >24 hours was also significantly lower with LBBAP compared with BVP (0.7% vs 2.9%;p=0.015). Conclusions: LBBAP was associated with lower incidence of sustained VT/VF and new-onset AF compared with BVP. This difference remained significant after adjustment for differences in baseline characteristics between patients with BVP and LBBAP. Physiologic resynchronization by LBBAP may be associated with lower risk of arrhythmias compared with BVP.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Proarrhythmia Encountered In Patients With Bvpmentioning

confidence: 99%

Arrhythmic Risk in Biventricular Pacing Compared With Left Bundle Branch Area Pacing: Results From the I-CLAS Study

Herweg,

Sharma,

Cano

et al. 2024

Circulation

Self Cite

View full text Add to dashboard Cite

show abstract

“…In the past decade, CSP, with HBS or left bundle branch stimulation (LBBS), has been increasingly utilized, facilitated by the development of current tools and techniques. [14][15][16] Conduction system stimulation has been mostly used in patients with LVD as an alternative to CRT. [17][18][19][20] Importantly, the vast majority of patients with the need for chronic cardiac stimulation have normal or near-normal LVEF, but data about CSP capabilities to prevent LVD in patients with normal or mildly deteriorated LVEF and a high burden of ventricular stimulation are still scarce.…”

mentioning

confidence: 99%

Conduction System Stimulation to Avoid Left Ventricle Dysfunction

González-Matos,

Rodríguez-Queralto,

Záraket

et al. 2024

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

BACKGROUND: Right ventricular apical pacing (RVAP) can produce left ventricle dysfunction. Conduction system pacing (CSP) has been used successfully to reverse left ventricle dysfunction in patients with left bundle branch block. To date, data about CSP prevention of left ventricle dysfunction in patients with preserved left ventricular ejection fraction (LVEF) are scarce and limited mostly to nonrandomized studies. Our aim is to demonstrate that CSP can preserve normal ventricular function compared with RVAP in the setting of a high burden of ventricular pacing. METHODS: Consecutive patients with a high-degree atrioventricular block and preserved or mildly deteriorated LVEF (>40%) were included in this prospective, randomized, parallel, controlled study, comparing conventional RVAP versus CSP. RESULTS: Seventy-five patients were randomized, with no differences between basal characteristics in both groups. The stimulated QRS duration was significantly longer in the RVAP group compared with the CSP group (160.4±18.1 versus 124.2±20.2 ms; P <0.01). Seventy patients were included in the intention-to-treat analyses. LVEF showed a significant decrease in the RVAP group at 6 months compared with the CSP group (mean difference, −5.8% [95% CI, −9.6% to −2%]; P <0.01). Left ventricular end-diastolic diameter showed an increase in the RVAP group compared with the CSP group (mean difference, 3.2 [95% CI, 0.1–6.2] mm; P =0.04). Heart failure–related admissions were higher in the RVAP group (22.6% versus 5.1%; P =0.03). CONCLUSIONS: Conduction system stimulation prevents LVEF deterioration and heart failure–related admissions in patients with normal or mildly deteriorated LVEF requiring a high burden of ventricular pacing. These results are only short term and need to be confirmed by further larger studies. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT06026683.

show abstract

“…In light of this information and our experience, we are convinced that right ventricular pacing is fundamentally inappropriate treatment for bradycardia. It increases ventricular dyssynchrony, while His bundle pacing and left bundle branch pacing do not [4].The pacemaker's primary purpose should be to keep an adequate heart rate and preserve the atrioventricular and ventricular synchrony as close to the physiological state as possible. Moreover, it should also follow other physiological needs of the human organism: not only a decline in the basal heart rate during rest or sleep but also a change in the heart rate in concordance with breathing [5].…”

mentioning

confidence: 99%

Additional factors underlying pacing-induced cardiomyopathy in patients who underwent right ventricular pacing and His bundle pacing. Author’s reply

Mizner,

Waldauf,

Grieco

et al. 2024

Polish Heart J

View full text Add to dashboard Cite

Cardiac Conduction System Pacing

Cited by 15 publications

References 65 publications

Arrhythmic Risk in Biventricular Pacing Compared With Left Bundle Branch Area Pacing: Results From the I-CLAS Study

Arrhythmic Risk in Biventricular Pacing Compared With Left Bundle Branch Area Pacing: Results From the I-CLAS Study

Conduction System Stimulation to Avoid Left Ventricle Dysfunction

Additional factors underlying pacing-induced cardiomyopathy in patients who underwent right ventricular pacing and His bundle pacing. Author’s reply

Contact Info

Product

Resources

About