Bilateral Bundle Branch Area Pacing to Achieve Physiological Conduction System Activation.

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Left bundle branch pacing (LBBP) is a conduction system pacing technique.
• LBBP can lead to right bundle branch block morphology on electrocardiograms (ECGs).
• Achieving synchronous ventricular activation is a clinical challenge in pacing.

Purpose of the Study:

• To assess simultaneous pacing of both left and right bundle branch areas (Bilateral Bundle Branch Area Pacing - BBBP).
• To evaluate if BBBP can achieve more synchronous ventricular activation than LBBP.
• To analyze the impact of BBBP on QRS duration and ventricular activation times.

Main Methods:

• BBBP was performed in symptomatic bradycardia patients using a transventricular-septal approach.
• A bipolar pacing lead's distal electrode paced the left bundle branch area, while the ring electrode paced the right bundle branch area.
• Measurements included QRS duration, right ventricular activation time, left ventricular activation time, and interventricular conduction delay.

Main Results:

• BBBP was successful in 22 of 36 patients.
• BBBP significantly shortened QRS duration compared to LBBP (109.3±7.1 ms vs 118.4±5.7 ms).
• BBBP resolved or partially corrected the right bundle branch block morphology seen with LBBP, improving ventricular activation times.

Conclusions:

• BBBP offers a more physiological approach to ventricular activation than LBBP.
• BBBP can diminish interventricular activation delays associated with LBBP.
• This technique holds promise for improving pacing outcomes in select bradycardia patients.