Comparison of synchronization between left bundle branch and his bundle pacing in atrial fibrillation patients: An intra‐patient‐controlled study

Abstract

Background His bundle pacing (HBP) is a physiological pacing strategy to preserve the electrical synchrony of ventricular conduction and left ventricular (LV) function. Left bundle branch pacing (LBBP) has emerged as an alternative physiological pacing technique. Objective To evaluate cardiac electrical and mechanical synchrony comparing LBBP and HBP in patients with permanent atrial fibrillation (AF). Methods Consecutive patients with symptomatic bradycardia and AF were enrolled from January to June of 2019. The cardiac electrical and mechanical synchrony in different pacing mode were evaluated at baseline and after implantation. Results Both HBP and LBBP were performed in 20 patients. LBBP significantly widened the QRS duration compared with the intrinsic conduction (113.2 ± 14.5 vs. 96.5 ± 16.2 ms; p = .01), while HBP did not (104.5 ± 22.3 vs. 96.5 ± 16.2 ms; p = .12). Both LBBP and HBP patients had similar LV myocardial strain measurements for the mechanical synchrony evaluation without significant change compared with baseline. There was no significant difference in right ventricular synchrony measurement between LBBP and HBP. Compared to HBP, LBBP had less interventricular synchrony (IMVD, 14.7 ± 9.2 vs. 3.1 ± 12.7 ms, p < .01; Ts‐LV‐RV, 37.9 ± 10.7 vs. 18.5 ± 10.8 ms, p < .001). Conclusions Although LBBP's a physiological pacing mode can achieve a similar cardiac electrical and mechanical synchronization when compared to HBP, LBBP results in modest delay in RV activation, and the clinical implication remains to be studied.

Pacing Characteristics of His Bundle Pacing vs. Left Bundle Branch Pacing: A Systematic Review and Meta-Analysis

“…In total, four studies ( 17 , 18 , 20 , 22 ) reported R wave amplitudes. As shown in Figure 3A , our study found that the sensed R wave amplitude at implantation of LBBP recipients was larger than HBP recipients (MD: 7.23, 95% CI: 5.29–9.16, P < 0.0001).…”

“…In total, four studies ( 17 , 20 – 22 ) reported the paced capture threshold at implantation and follow-up. A statistically significant difference was observed at implantation and follow-up in capture threshold.…”

“…QRS duration was evaluated in six studies, including five studies ( 15 , 17 , 20 – 22 ) that reported the native QRS duration and the paced QRS duration at implantation and two studies ( 17 , 18 ) that reported the native QRS duration and the paced QRS duration at follow-up.…”

Clinical Outcomes Associated With His-Purkinje System Pacing vs. Biventricular Pacing, in Cardiac Resynchronization Therapy: A Meta-Analysis

“…HPSP, a physiological pacing modality that directly stimulates the conduction system of the heart and maintains synchronization of ventricular electrical activation has produced better results compared to BIVP in clinical practice (41,45). Lustgarten et al (11) summarized the clinical outcome data from a 2015 study of 12 patients with a mean baseline LVEF of 26%; at the 6-month follow-up, HBP was shown to improve by 32% and BIVP by 31% (P = 0.043 and P = 0.02, respectively); the baseline NYHA grades for HBP and BIVP improved from 2.9 to 1.9 (P < 0.01 and P < 0.01, respectively).…”

“…Further details regarding the studies analyzed are shown in Table 1. The 18 included studies (11,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45), which were RCTs and observational studies, were scored using the Jadad scoring system and the NOS quality assessment system, as shown in Figures 2A,B.…”