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The Implantation of Left Bundle Branch Area Pacing in Patients with and without Bundle Branch Block

Tian-Ping Chen1, Xiao-Jun Shi1, Dong-Yu Lu1

  • 1Department of Cardiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China.

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
|October 25, 2021
PubMed

Insights

Left bundle branch area pacing (LBBAP) is a safe and effective pacing strategy. Compared to right ventricular septum pacing (RVSP), LBBAP significantly reduces QRS duration and left ventricular activation time, especially in patients with left bundle branch block morphology.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Pacing

Background:

  • Left bundle branch area pacing (LBBAP) is an emerging technique for physiological cardiac pacing.
  • Understanding its safety and electrocardiogram (ECG) characteristics is crucial for clinical adoption.

Purpose of the Study:

  • To investigate the clinical safety and ECG characteristics of LBBAP.
  • To compare LBBAP with right ventricular septum pacing (RVSP).

Main Methods:

  • A retrospective study was conducted involving patients undergoing LBBAP for bradycardia.
  • Pacing parameters and ECG characteristics (QRS duration, stimulus to peak left ventricular activation time) were measured for both LBBAP and RVSP.
  • Patients with pre-existing left bundle branch block (LBBB) morphology were analyzed separately.

Main Results:

  • LBBAP resulted in right bundle branch block (RBBB) morphology on ECG, unlike RVSP which caused LBBB morphology.
  • LBBAP demonstrated significantly higher sensing amplitude, shorter QRS duration, and shorter stimulus to peak left ventricular activation time compared to RVSP.
  • Patients with intrinsic LBBB morphology showed the greatest reduction in paced QRS duration and stimulus to peak left ventricular activation time with LBBAP.
  • No complications or adverse events were observed during implantation or follow-up (9.2 ± 3.7 months).

Conclusions:

  • LBBAP is a safe and feasible pacing strategy.
  • LBBAP offers significant advantages in reducing QRS duration and left ventricular activation time compared to RVSP.
  • LBBAP may be a promising option for patients with LBBB morphology requiring ventricular pacing.
Abstract

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