Immediate clinical outcomes of left bundle branch area pacing vs conventional right ventricular pacing

Zhang, Junmeng; Wang, Zefeng; Cheng, Liao‐Ping; Zu, Linna; Liang, Zhuo; Hang, Fei; Wang, Xinlu; Li, Xiaoyan; Su, Ruijuan; Du, Jie; Wu, Yongquan

doi:10.1002/clc.23215

Cited by 72 publications

(75 citation statements)

References 16 publications

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“…LBB fans out directly from the branching point of His bundle beneath the membranous septum with well‐defined dimensions 18 . In light of LBB's anatomy, satisfied lead parameters could be expected 19 . In this study, we confirmed that capture threshold, impedance, and R‐wave amplitude of LBBP were comparable with that of traditional RVA pacing and remained stable throughout the whole observation period.…”

Section: Discussionsupporting

confidence: 69%

Short‐term and intermediate‐term performance and safety of left bundle branch pacing

Guo

Meng

et al. 2020

Cardiovasc electrophysiol

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Introduction: Left bundle branch pacing (LBBP) is a promising new method for patients with pacing indications. This study aims to evaluate the safety and feasibility of LBBP in a relatively longer time span. Methods and Results: A total of 164 patients were recruited for LBBP in this study. Among these patients, 148 patients had pacing indications due to symptomatic bradycardia while the other 16 patients had indications for cardiac resynchronization therapy (CRT). LBBP was successful in 89.0% (146/164) of all recruited patients.Intracardiac and surface electrographic parameters and image data were documented during the LBBP procedure. The mean paced QRS duration (pQRSD) and the mean stimulus to left ventricular activation time (stim-LVAT) was 106.0 ± 12.9 ms and 64.4 ± 13.7 ms respectively. Left bundle branch (LBB) potentials were recorded in 89 patients. Forty-three of whom had sick sinus syndrome (SSS), and 46 had atrioventricular block (AVB). The presence of LBB potential was more common in patients with SSS (82.7% vs 57.5%, P = .002). No significant differences in pQRSD, stim-LVAT, or capture threshold were detected between patient groups with or without LBB potential. Patients were followed up at 1 month, 3 months, 6 months, and 1 year after the procedure. Pacing parameters and the echocardiographic data remained stable within a mean follow-up period of 8.6 ± 4.3 months. No serious complication caused by this procedure was found in this study.Conclusions: Successful LBBP carried an aspect of short pQRSD and stim-LVAT while the LBB potential was not the prerequisite and necessary feature. The LBBP procedure had a high success rate with satisfied and stable lead parameters during short and intermediate-term observations. K E Y W O R D S feasibility, intermediate-term, left bundle branch pacing, left bundle branch potential, safety ---This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Pacing-QRS duration (ms) 106.0 ± 12.9Stim-LVAT (ms) 64.4 ± 13.7Abbreviations: AVB, atrioventricular block; ECG, electrocardiogram; CLBBB, complete left bundle branch block; CRBBB, complete right bundle branch; CRT, cardiac resynchronization therapy; LBB, left bundle branch; LBBP, left bundle branch pacing; PVI, potential to ventricular interval; stim-LVAT, stimulus to left ventricular activation time. 1474| GUO ET AL.

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Section: Discussionsupporting

confidence: 69%

Short‐term and intermediate‐term performance and safety of left bundle branch pacing

Guo

Meng

et al. 2020

Cardiovasc electrophysiol

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“…These ECG characteristics produced by LBBAP in the present study are consistent with findings reported in recent publications. [13][14][15]17,18 Moreover, no major implantation-related complications such as ventricular septal perforation, local tissue damage, or pacing lead dislodgment were observed, and the low pacing capture threshold remained stable during follow-up. Thus, LBBAP is technically feasible and safe in patients with HF and LBBB and indicated for CRT.…”

Section: Discussionmentioning

confidence: 90%

“…[11][12][13] Initial investigations have shown the clinical feasibility of left bundle branch area pacing (LBBAP) and demonstrated that LBBAP can provide relatively narrow QRSd, fast peak left ventricular activation time (LVAT), and LBBB correction with a low and stable pacing output. [11][12][13][14][15] We hypothesized that LBBAP could be another approach to achieve cardiac resynchronization by providing LV activation synchrony. The objective of the present study was to assess the clinical feasibility, safety, and efficacy of LBBAP in patients with HF and LBBB.…”

Section: Introductionmentioning

confidence: 99%

Cardiac resynchronization therapy by left bundle branch area pacing in patients with heart failure and left bundle branch block

et al. 2019

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BACKGROUND Cardiac resynchronization therapy (CRT) via biventricular pacing has demonstrated clinical benefits in patients with heart failure (HF) and ventricular dyssynchrony. Other approaches of CRT is little known. OBJECTIVE The purpose of this study was to assess the feasibility, safety, and efficacy of left bundle branch area pacing (LBBAP) in patients with HF and left bundle branch block (LBBB). METHODS Eleven consecutive patients with HF, reduced left ventricular ejection fraction and LBBB and indicated for CRT were recruited. LBBAP was achieved via transventricular septal approach and characterized by narrower QRS duration, shortened peak left ventricular activation time, and right bundle branch conduction delay on the electrocardiogram. Electrocardiogram, echocardiogram, and cardiac function were evaluated at baseline and follow-up. Interventricular mechanical delay and 3-dimensional tissue synchronization imaging during LBBAP and intrinsic LBBB status were measured by echocardiography at follow-up. RESULTS LBBAP significantly shortened QRS duration (from baseline 180.00 6 15.86 ms to 129.09 6 15.94 ms; P , .01) and left ventricular activation time (from baseline 108.18 6 15.54 ms to 80.91 6 9.95 ms; P , .01). Interventricular mechanical delay and the standard deviation of tissue synchronization imaging of 12 left ventricular (LV) segments were significantly shorter during LBBAP than in intrinsic LBBB status (both with P , .01). At a mean follow-up period of 6.7 months, New York Heart Association functional class, plasma level of B-type natriuretic peptide, LV end-systolic diameter, and left ventricular ejection fraction were significantly improved (all with P , .05 vs baseline). CONCLUSION The study demonstrates that LBBAP is clinically feasible in patients with systolic HF and LBBB. LBBAP can be a new CRT technique to correct LBBB, provide ventricular synchrony, and improve clinical symptoms with LV reverse remodeling.

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“…In our previous study, we convinced that LBBP may bring about better electrical and mechanical synchrony compared with RVP 7 . Some studies also confirmed the short‐term and medium‐term feasibility and stability of LBBP 27‐29 . It has been proved that reduction in electric dyssynchrony was reflected by the shorter QRS duration and stim‐LVAT during LBBP, which could translate to acute hemodynamic effects compared with RVP 7,27 .…”

Section: Discussionmentioning

confidence: 88%

Feasibility and stability of left bundle branch pacing in patients after prosthetic valve implantation

Guo

Xiao

et al. 2020

Clinical Cardiology

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Background: Left bundle branch pacing (LBBP) has emerged as a promising pacing modality for preventing pacing induced cardiomyopathy in patients complicated with conduction abnormalities (CAs) after prosthetic valve (PV) implantation. Objective: The present study aimed to evaluate the safety and feasibility of LBBP in this patient population. Methods: LBBP was attempted in 20 patients complicated with atrioventricular block after PV implantation. Surface, intracardiac electrical measurements, and echocardiographic data were documented. Lead parameters and complications were routinely tracked at implantation and each follow-up visit. Results: LBBP was successful in 90% (18/20) participants. The paced QRS duration and the stimulus to left ventricular activation time were 106.8 ± 6.8 ms and 65.5 ± 5.4 ms, respectively. Left bundle branch (LBB) potential was recorded in 61.1% (11/18) patients who succeeded in LBBP. During the procedure, the mean unipolar myocardium capture threshold was 0.51 ± 0.15 V@0.4 ms while the unipolar bundle capture threshold was 0.84 ± 0.51 V@0.4 ms. The mean fluoroscopic exposure time and the radiation dose were 13.0 ± 9.2 min and 81.7 ± 8.3 mGy, respectively. The average follow-up period was 10.4 ± 5.9 months (range 3-23 months). Pacing parameters remained stable and no significant lead-related complications occurred during the whole observation period. Conclusions: LBBP was safe and feasible in patients with PVs. Acceptable and stable pacing parameters could be expected during the procedure and the follow-ups. K E Y W O R D S left bundle branch pacing, permanent pacemaker implantation, physiological pacing, prosthetic valves 1 | INTRODUCTION Atrioventricular heart block is a common complication in patients received prosthetic valve (PV) implantation. The incidences ranging Jincun Guo and Linlin Li contributed equally to this work.

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Immediate clinical outcomes of left bundle branch area pacing vs conventional right ventricular pacing

Cited by 72 publications

References 16 publications

Short‐term and intermediate‐term performance and safety of left bundle branch pacing

Short‐term and intermediate‐term performance and safety of left bundle branch pacing

Cardiac resynchronization therapy by left bundle branch area pacing in patients with heart failure and left bundle branch block

Feasibility and stability of left bundle branch pacing in patients after prosthetic valve implantation

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