Clinical outcomes of left bundle branch pacing compared to right ventricular apical pacing in patients with atrioventricular block

Abstract

Background Left bundle branch pacing (LBBP) can produce near normalization of QRS duration. This has recently emerged as alternative technique to right ventricular pacing and His bundle pacing. Hypothesis The purpose of this study is to evaluate clinical outcomes of LBBP compared to right ventricular apical pacing (RVAP). Methods A total of 70 AVB patients with indications for ventricular pacing were retrospectively studied. LBBP was attempted in 33 patients, classified as LBBP group. The other patients were classified as RVAP group. Pacing parameters, electrocardiogram and echocardiogram characteristics, heart failure hospitalization (HFH), and atrial fibrillation (AF) were evaluated perioperatively and at follow‐ups. Patients were followed in the device clinic for a minimum of 12 months and up to 24 months at a 3–6 monthly interval. Results LBBP was successful in 29 of 33(87.9%) patients while all 37 of the remaining patients successfully underwent RVAP. Paced QRS duration was significantly narrower in the LBBP group compare to RVAP(110.75 ± 6.77 ms vs. 154.29 ± 6.96 ms, p = .000) at implantation, and the difference persisted during follow‐ups. Pacing thresholds (at implantation: 0.68 ± 0.22 V in the LBBP group and 0.73 ± 0.23 V in the RVAP group, p = .620) remained low and stable during follow‐ups. The cardiac function in the LBBP group remained stable during follow‐ups (LVEF%:55.08 ± 4.32 pre‐operation and 54.17 ± 4.34 at the end of follow‐up, p = .609), and better than RVAP group (LVEF%: 54.17 ± 4.34 vs. 50.14 ± 2.14, p = .005). Less HFH was observed in the LBBP group (2/29,6.89%) compared to RVAP group (10/37,27.03%). Conclusions The present investigation demonstrates the safety and feasibility of LBBP that produces narrower paced QRS duration than RVAP. LBBP is associated with reduction in the occurrence of pacing‐induced left ventricular dysfunction and HFH compared to RVAP in patients requiring permanent pacemakers.

Prospective evaluation of clinical safety and efficacy of left bundle branch area pacing in comparison with right ventricular sepal pacing

“…However, no statistical difference existed in LVEDD and LVEF between the LBBaP and RVSP groups during middleterm follow-up in our study, which were identical to other short term follow-up studies [13,20]. One possible reason for this difference is that patients enrolled into the two studies were different, patients with BBB or AV block were enrolled into Das's study [24] and patients with AV block were enrolled into Zhang's study [14], resulting in most of patients with high ventricular pacing ratio. By subgroup analysis, our study also showed that LV function is better (higher LVEF and lower LVEDD, P < .05) in the LBBaP-H group compared with the RVSP-H group.…”

“…When the edema was reduced, the impedance gradually decreased, R-wave amplitudes gradually increased and tended to be stable. Other studies also con rmed good pacing parameters for LBBaP [11,14,17].…”

“…Das's study [24] and Zhang' study [14] showed that LBBaP is associated with better LV function (higher LVEF and lower LVEDD, P < .05) during short-middle term follow-up in comparison to RVAP. However, no statistical difference existed in LVEDD and LVEF between the LBBaP and RVSP groups during middleterm follow-up in our study, which were identical to other short term follow-up studies [13,20].…”

“…Subsequently, the narrow paced QRS duration (QRSd), good ventricular mechanical synchrony and a low capture threshold of LBBaP has been con rmed by several studies [11,12]. However, the results of comparison of left ventricular (LV) function such as left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) between LBBaP and right ventricular pacing (RVP) were inconsistent in several studies [13,14]. In this study, we aimed to evaluate the clinical safety, e cacy and LV function of LBBaP compared to RVSP.…”

His‐Purkinje conduction system pacing: A systematic review and network meta‐analysis in bradycardia and conduction disorders

“…A total of 2182 articles were identified through initial database search, of which 713 duplicates and 1407 irrelevant records were excluded via title and abstract screening (Figure 1). After a full‐text assessment of the remaining 62 articles, we ultimately included 28 studies for further analysis 19‐46 . Overall, 4160 patients were involved with a mean age of 70.9 years, comprising 2379 (57.2%) men and 1781 (42.8%) women.…”