Short QRS Duration After His-Purkinje Conduction System Pacing Predicts Left Ventricular Complete Reverse Remodeling in Patients With True Left Bundle Branch Block and Heart Failure

Guan, Xiaoqian; Li, Dan-Na; Zhao, Fangyuan; Zhao, Yan-Ni; Yang, Yanzong; Dai, Bai-Ling; Dai, Shiyu; Gao, Lianjun; Xia, Yunlong; Dong, Ying-Xue

doi:10.3389/fcvm.2022.824194

Cited by 5 publications

(1 citation statement)

References 34 publications

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“…In contrast, HPCSP achieves physiological pacing by agitating the endogenous conduction system of the heart to avoid cardiac desynchronization and left ventricular dysfunction, thereby restoring the normal sequence of right and left ventricular excitation, and has received extensive attention from experts and scholars at home and abroad ( 38 – 40 ).…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of His-Purkinje system pacing in the treatment of patients with atrial fibrillation and heart failure: a systematic review and meta-analysis

Guan,

Wang,

Guan

et al. 2023

Front. Cardiovasc. Med.

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AimTo evaluate the safety and efficacy of the His-Purkinje system pacing (HPCSP) in the treatment of individuals with atrial fibrillation (AF) complicated by heart failure (HF).MethodsThe PubMed, Cochrane Library, Web of Science, and Embase databases were searched through September 1, 2022. The literature was initially screened based on the inclusion and exclusion criteria. The baseline characteristics of the subjects, implantation success rate, New York Heart Association (NYHA) classification, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), QRS duration, pacing threshold, and impedance were extracted and summarized; statistical analysis was performed using RevMan 5.3 software.ResultsIn all, 22 articles were included, involving 1,445 patients. Compared to biventricular pacing (BiVP), HPCSP resulted in improved cardiac function, including increased ejection fraction (MD = 5.69, 95% CI: 0.78–10.60, P = 0.02) and decreased LVEDd (MD = −3.50, 95% CI: −7.05–0.05, P = 0.05). It was also correlated with shorter QRS duration (MD = −38.30, 95% CI: −60.71–−15.88, P < 0.01) and reduced all-cause mortality and rehospitalization events (RR = 0.72, 95% CI: 0.57–0.91, P < 0.01) in patients. Left bundle branch pacing (LBBP) lowered the pacing threshold (MD = 0.47; 95% CI: 0.25–0.69; P < 0.01), and there was no statistical difference in the rate of endpoint events when comparing these two physiologic pacing modalities (RR = 1.56, 95% CI: 0.87–2.80, P = 0.14).ConclusionThe safety and efficacy of HPCSP in patients with AF and HF were verified in this meta-analysis. HPCSP can reverse cardiac remodeling and has great clinical application value. Relatively speaking, His-bundle pacing (HBP) can maintain better ventricular electro-mechanical synchronization, and the pacing parameters of LBBP are more stable.Systematic Review RegistrationPROSPERO (CRD42022336109)

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of His-Purkinje system pacing in the treatment of patients with atrial fibrillation and heart failure: a systematic review and meta-analysis

Guan,

Wang,

Guan

et al. 2023

Front. Cardiovasc. Med.

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Cardiac magnetic resonance–derived myocardial scar is associated with echocardiographic response and clinical prognosis of left bundle branch area pacing for cardiac resynchronization therapy

Chen,

Ma,

Gao

et al. 2023

Europace

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Aims Left bundle branch area pacing (LBBAP) is a novel approach for cardiac resynchronization therapy (CRT), but the impact of myocardial substrate on its effect is poorly understood. This study aims to assess the association of cardiac magnetic resonance (CMR)–derived scar burden and the response of CRT via LBBAP. Methods and results Consecutive patients with CRT indications who underwent CMR examination and successful LBBAP-CRT were retrospectively analysed. Cardiac magnetic resonance late gadolinium enhancement was used for scar assessment. Echocardiographic reverse remodelling and composite outcomes (defined as all-cause death or heart failure hospitalization) were evaluated. The echocardiographic response was defined as a ≥15% reduction of left ventricular end-systolic volume. Among the 54 patients included, LBBAP-CRT resulted in a 74.1% response rate. The non-responders had higher global, septal, and lateral scar burden (all P < 0.001). Global, septal, and lateral scar percentage all predicted echocardiographic response [area under the curve (AUC): 0.857, 0.864, and 0.822; positive likelihood ratio (+LR): 9.859, 5.594, and 3.059; and negative likelihood ratio (−LR): 0.323, 0.233, and 0.175 respectively], which was superior to QRS morphology criteria (Strauss left bundle branch abnormality: AUC: 0.696, +LR 2.101, and −LR 0.389). After a median follow-up time of 20.3 (11.5–38.7) months, higher global, lateral and septal scar burdens were all predictive of the composite outcome (hazard ratios: 4.996, 7.019, and 4.741, respectively; P’s < 0.05). Conclusion Lower scar burden was associated with higher response rate of LBBAP-CRT. The pre-procedure CMR scar evaluation provides further useful information to identify potential responders and clinical outcomes.

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Comparison of Upgrading to Conduction System Pacing and Biventricular Pacing in Patients with Pacemaker-induced Cardiomyopathy

Chen,

Ma,

Yang

et al. 2023

Preprint

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Background: Pacemaker-induced cardiomyopathy (PICM) is common in patients with right ventricular pacing (RVP). We are still not clear whether the conduction system pacing (CSP) upgrade is better than the traditional biventricular pacing (BiVP) upgrade. Objective: To illustrate the performances of different upgrade modalities in patients with PICM. Methods: All patients with PICM were consecutively enrolled and followed for at least one year regardless of resynchronization upgrade from 2017 to 2021. Clinical data, including echocardiographic parameters, electrocardiogram measurements and cardiac function, were collected and compared. Results: A total of 73 patients were enrolled. Forty-eight patients had a resynchronization upgrade including 11 patients with BiVP, 24 patients with HBP and 13 patients with LBBP. The QRS duration (127.81±31.89 vs. 177.08±34.35ms, P<0.001), NYHA class (2.28±0.70 vs. 3.04±0.54, P<0.05), left ventricular end-diastolic diameter (LVEDD) (54.08±4.80 vs. 57.50±4.85mm, P<0.05) and LVEF (44.46±6.39 vs. 33.15±5.25%, P<0.001) improved significantly in patients with upgrade, while no improvement was detected in patients without upgrade. The range of improvement in QRS duration (59.65±11.71 vs. 34.67±13.32ms, P<0.001), LVEDD (5.80±1.71 vs. 3.16±1.35mm, P<0.001), LVEF (12.80±3.66 vs. 6.93±3.04%, P<0.001) were more significant in patients with CSP compared with BiVP. However, the range of improvement of LVEDD and LVEF were not different between LBBP and HBP. The threshold in LBBP was lower than HBP (1.01±0.43 vs. 1.33±0.32V, P=0.019). Conclusion: The improvement of clinical outcomes in CSP were more significant than in BiVP. CSP may be an alternative therapy of CRT in patients with PICM. LBBP would be a better choice for achieving lower thresholds compared with HBP.

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Short QRS Duration After His-Purkinje Conduction System Pacing Predicts Left Ventricular Complete Reverse Remodeling in Patients With True Left Bundle Branch Block and Heart Failure

Cited by 5 publications

References 34 publications

Safety and efficacy of His-Purkinje system pacing in the treatment of patients with atrial fibrillation and heart failure: a systematic review and meta-analysis

Safety and efficacy of His-Purkinje system pacing in the treatment of patients with atrial fibrillation and heart failure: a systematic review and meta-analysis

Cardiac magnetic resonance–derived myocardial scar is associated with echocardiographic response and clinical prognosis of left bundle branch area pacing for cardiac resynchronization therapy

Comparison of Upgrading to Conduction System Pacing and Biventricular Pacing in Patients with Pacemaker-induced Cardiomyopathy

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