Cardiac resynchronization therapy by left bundle branch area pacing in patients with heart failure and left bundle
Weiwei Zhang1, Jingjuan Huang1, Yiding Qi1
1Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Insights
Left bundle branch area pacing (LBBAP) is a feasible new technique for cardiac resynchronization therapy (CRT) in heart failure (HF) patients with left bundle branch block (LBBB). This approach improves ventricular synchrony and cardiac function.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) using biventricular pacing benefits heart failure (HF) patients with ventricular dyssynchrony.
- Alternative CRT methods beyond biventricular pacing are less understood.
Purpose of the Study:
- To evaluate the feasibility, safety, and efficacy of left bundle branch area pacing (LBBAP) in patients diagnosed with HF and left bundle branch block (LBBB).
Main Methods:
- Eleven patients with HF, reduced ejection fraction, and LBBB underwent LBBAP via a transventricular septal approach.
- Evaluated electrocardiogram (ECG), echocardiogram, and cardiac function at baseline and follow-up.
- Measured interventricular mechanical delay and 3D tissue synchronization imaging to assess ventricular synchrony.
Main Results:
- LBBAP significantly reduced QRS duration and left ventricular activation time (P < .01).
- Achieved significant improvements in interventricular mechanical delay and ventricular synchrony (P < .01).
- Demonstrated significant clinical improvements in HF symptoms, B-type natriuretic peptide levels, and left ventricular ejection fraction at 6.7 months follow-up (P < .05).
Conclusions:
- LBBAP is a clinically feasible technique for patients with systolic HF and LBBB.
- LBBAP offers a novel CRT approach to correct LBBB, enhance ventricular synchrony, and improve HF symptoms.
- The procedure promotes left ventricular reverse remodeling and improves cardiac function.
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 ± 15.86 ms to 129.09 ± 15.94 ms; P < .01) and left ventricular activation time (from baseline 108.18 ± 15.54 ms to 80.91 ± 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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