Left bundle branch area. A new site for physiological pacing: a pilot study

Das, Asit; Islam, Sk Sahidul; Pathak, Sushant Kumar; Majumdar, Ishita; Sharwar, Shah Alam; Saha, Rana; Chatterjee, Suman

doi:10.1007/s00380-020-01623-y

Cited by 15 publications

(35 citation statements)

References 33 publications

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“…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.…”

Section: Discussionsupporting

confidence: 73%

“…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].…”

Section: Discussionmentioning

confidence: 96%

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

Liu¹,

Li²,

Zeng³

et al. 2021

Preprint

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BackgroundLeft bundle branch area pacing (LBBaP) has recently emerged as alternative a new physiologic strategy of pacing to His-bundle pacing (HBP) associated with difficulty of lead implantation, His bundle damage, high and unstable thresholds.ObjectiveThe purpose of this study is to compare clinical safety and efficacy of LBBaP with right ventricular sepal pacing (RVSP).MethodsFrom February 2019 to May 2020, consecutive pacing-indicated patients were prospectively enrolled and divided into two groups. Ventricular synchrony index such as QRS duration (QRSd), interventricular mechanical delay (IVMD) and septal-posterior wall motion delay (SPWMD), left ventricular function such as left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF), pacing parameters, and complications were evaluated in perioperative period and during follow-up.ResultsLBBaP was successful in 45 patients (88.2%), and finally 46 patients underwent RVSP. With LBBaP, the ventricular electrical- mechanical synchrony were similar with the native-conduction system (P = .784). However, the ventricular electrical synchrony (QRSd, 108.47 ± 7.64 vs 130.63 ± 13.63 ms, P < .0001) and mechanical synchrony (IVMD, 27.68 ± 4.33 vs 39.88 ± 5.83, P < .0001; SPWMD, 40.39 ± 23.21 vs 96.36 ± 11.55, P < .0001) in the LBBaP group were significantly superior to the RVSP group. No significant differences in LVEDD (46 [44-48.5] vs 47 [44–52] mm, P = .488) and LVEF% (66 [62.5–70] vs 64 [61–68], P = .759) were noted in both two groups at last follow-up. But, in the subgroup analysis, LVEDD was shorter (46 [44–49] vs 50 [47–58] mm, P = .032) and the LVEF% was higher (65 [62–68] vs 63 [58–65], P = .022) in the LBBaP-H (high ventricular pacing ratio > 40%) group compared with RVSP-H group at last follow-up. There was lower capture thresholds (0.59 ± 0.18V vs. 0.71 ± 0.26V, P = 0.011) at implantation in the LBBaP group than RVSP group, and R-wave amplitudes and pacing impedances did not differ between the two groups. No serious complications were found in both two groups at implantation and follow-ups.ConclusionThis study confirms the clinical safety and efficacy of LBBaP, and that produces better ventricular electrical-mechanical synchrony than RVSP. The event of pacing-induced left ventricular dysfunction is lower in the LBBaP-H group than RVSP-H group.Trial registrationTrial registration Chinese Clinical Trial Registry, ChiCTR2100046901, Registered 30 May 2021—Retrospectively registered, http://www.chictr.org.cn/searchproj.aspx?regstatus=1008001.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 96%

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

Liu¹,

Li²,

Zeng³

et al. 2021

Preprint

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“…[ 19 ] It is worth noting that left ventricular (LV) mechanical synchrony was measured in different ways. In Cai et al study, [ 19 ] it was measured by SD-Tmsv-16; In Das et al's study, [ 21 ] it was measured by standard pulsed wave Doppler echocardiography as the interval between the onset of the QRS and the onset of the aortic and pulmonary ejection; In Sun et al study, [ 23 ] it was measured by standard deviation of 18-segment systolic times to peak 2-D strain.…”

Section: Resultsmentioning

confidence: 99%

“…The baseline of LV mechanical synchrony measured by different ways was summarized from 3 studies [ 19 , 21 , 23 ] and the heterogeneity was low ( I 2 = 45%), taking a fixed-effect model and the continuous variables were analyzed using SMD. In the LBBP group, LV mechanical synchronization parameter of the LBBP capture was similar with the native-conduction mode (WMD: −0.01; 95% CI, −0.33 to 0.31, P = .95; Fig.…”

Section: Resultsmentioning

confidence: 99%

Safety and efficacy of left bundle branch pacing in comparison with conventional right ventricular pacing

Liu

Li²,

Wang³

et al. 2021

Medicine

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Background: Right ventricular pacing (RVP) has been widely accepted as a traditional pacing strategy, but long-term RVP has detrimental impact on ventricular synchrony. However, left bundle branch pacing (LBBP) that evolved from His-bundle pacing could maintain ventricular synchrony and overcome its clinical deficiencies such as difficulty of lead implantation, His bundle damage, and high and unstable thresholds. This analysis aimed to appraise the clinical safety and efficacy of LBBP. Methods: The Medline, PubMed, Embase, and the Cochrane Library databases from inception to November 2020 were searched for studies comparing LBBP and RVP. Results: Seven trials with 451 patients (221 patients underwent LBBP and 230 patients underwent RVP) were included in the analysis. Pooled analyses verified that the paced QRS duration (QRSd) and left ventricular mechanical synchronization parameters of the LBBP capture were similar with the native-conduction mode ( P > .7),but LBBP showed shorter QRS duration (weighted mean difference [WMD]: −33.32; 95% confidence interval [CI], −40.44 to −26.19, P < .001), better left ventricular mechanical synchrony (standard mean differences: −1.5; 95% CI: −1.85 to −1.14, P < .001) compared with RVP. No significant differences in Pacing threshold (WMD: 0.01; 95% CI: −0.08 to 0.09, P < .001), R wave amplitude (WMD: 0.04; 95% CI: −1.12 to 1.19, P = .95) were noted between LBBP and RVP. Ventricular impedance of LBBP was higher than that of RVP originally (WMD: 19.34; 95% CI: 3.13–35.56, P = .02), and there was no difference between the 2 groups after follow-up (WMD: 11.78; 95% CI: −24.48 to 48.04, P = .52). And follow-up pacing threshold of LBBP kept stability (WMD: 0.08; 95% CI: −0.09 to 0.25, P = .36). However, no statistical difference existed in ejection fraction between the 2 groups (WMD: 1.41; 95% CI: −1.72 to 4.54, P = .38). Conclusions: The safety and efficacy of LBBP was firstly verified by meta-analysis to date. LBBP markedly preserve ventricular electrical and mechanical synchrony compared with RVP. Meanwhile, LBBP had stable and excellent pacing parameters. However, LBBP could not be significant difference in ejection fraction between RVP during short- term follow-up.

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“…However, high pacing thresholds and low R-wave amplitudes limited the clinical application of HBP 7 . As the most potentially physiological pacing method, the left bundle branch area pacing (LBBAP) has been proved feasible, with stable parameters and many benefits 8,9 . Different from the traditional right ventricular pacing (RVP), the ventricular lead implantation in LBBAP is accomplished by the transventricular septal method.…”

Section: Introductionmentioning

confidence: 99%

Quantification of Acute Myocardial Damage Secondary to Implantation of Electrodes for the Left Bundle Branch Area Pacing

Chen

et al. 2021

RIC

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Background: Different from the traditional right ventricular pacing, the left bundle branch area pacing (LBBAP) is accomplished with deeper lead implantation and more attempts. However, myocardial damage is unclear in LBBAP. Objective: The objective of the study was to observe the change of troponin T and explore possible factors associated with greater myocardial damage in LBBAP. Methods: Patients with an indication for pacemaker implantation underwent attempts for LBBAP by transventricular septal method. Levels of troponin T were determined before operation, 12 h and 1 week after the operation. Parameters of intraoperation and follow-up were recorded and analyzed. Results: In total, successful LBBAP was achieved in 126 patients. The levels of troponin T increased significantly at 12 h after the operation compared with those before operation (96.45 ± 11.07 [69.06] vs. 16.59 ± 1.84 [11.92] ng/L, p < 0.001), while there were no significant differences between pre-and post-operative levels at 1 week. Correlation and regression analysis showed that only the number of attempts was an independent factor related to the change of troponin T. During 1 year of follow-up, LBBAP was safe and feasible with few complications. Conclusions: Myocardial damage of LBBAP was clinically significant. The number of attempts was an independent factor related to the myocardial damage. (REV INVEST CLIN. [AHEAD OF PRINT]

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Left bundle branch area. A new site for physiological pacing: a pilot study

Cited by 15 publications

References 33 publications

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

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

Safety and efficacy of left bundle branch pacing in comparison with conventional right ventricular pacing

Quantification of Acute Myocardial Damage Secondary to Implantation of Electrodes for the Left Bundle Branch Area Pacing

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