Effect of left bundle branch pacing on left ventricular systolic function and synchronization in patients with
Laiyu Yao1, Yuanjie Qi2, Shuxin Xiao3
1Qingdao University, Qingdao 266000, China.
Insights
Left bundle branch pacing (LBBP) improves left ventricular systolic function and synchronization in patients with third-degree atrioventricular block compared to right ventricular septal pacing (RVSP). LBBP offers better long-term outcomes for these patients.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- Third-degree atrioventricular block (AVB) necessitates pacing to restore cardiac function.
- Traditional right ventricular septal pacing (RVSP) may lead to dyssynchrony and impaired left ventricular function.
- Left bundle branch pacing (LBBP) is an emerging alternative pacing strategy.
Purpose of the Study:
- To compare the effects of LBBP versus RVSP on left ventricular systolic function.
- To evaluate the impact of LBBP versus RVSP on left ventricular synchronization.
- To assess long-term outcomes of LBBP in patients with third-degree AVB.
Main Methods:
- Fifty patients with third-degree AVB were randomized into LBBP and RVSP groups.
- Three-dimensional speckle tracking was used to measure left ventricular global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS).
- Left ventricular synchronization was assessed by Tmsv16-SD/R-R, and QRS duration was monitored over 18 months.
Main Results:
- LBBP demonstrated significantly higher GLS and GCS compared to RVSP at 18 months post-surgery.
- LBBP group showed improved synchronization, with significantly lower Tmsv16-SD/R-R and QRS duration compared to RVSP.
- Both pacing methods maintained stable left ventricular ejection fraction (LVEF) without significant differences.
Conclusions:
- LBBP significantly enhances left ventricular systolic function and electromechanical synchronization in patients with third-degree AVB.
- LBBP proves superior to RVSP in improving cardiac contractility and synchrony.
- LBBP is a promising pacing strategy for managing third-degree AVB, offering better functional outcomes.
Objective:
To explore the effect of left bundle branch pacing (LBBP) on left ventricular systolic function and synchronization in patients with third-degree atrioventricular block.
Methods:
Fifty patients with third-degree atrioventricular block from 2019- to 01-01 to 2019-6-31 in The Affiliated Hospital of Qingdao University who were eligible for pacing indications were selected. According to different pacing locations, they were randomly divided into LBBP group and right ventricular septal pacing (RVSP) group. Three-dimensional speckle tracking technology was used to collect left ventricular global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) before surgery, 6 months after surgery, 12 months after surgery, and 18 months after surgery. At the same time, the percentage of the standard deviation of the time when the left ventricular 16 segments reach the minimum systolic volume in the cardiac cycle (Tmsv16-SD/R-R) was calculated. And the QRS duration of the two groups was followed up.
Results:
1. GLS in LBBP group and RVSP group after surgery was significantly higher than that before surgery. And GLS in LBBP group and RVSP group showed an upward trend after surgery. However, the increase rate in LBBP group was higher than that in RVSP group. At 18 months after surgery, LBBP group was significantly higher than that in RVSP [(29.92±4.73) vs (26.48±3.80), p<0.05]. GCS in LBBP group increased gradually after surgery. GCS in RVSP group was no significant change after surgery. At 18 months after surgery, GCS in RVSP group was significantly lower than that in LBBP group [(27.92±3.37) vs (29.48±4.40), p<0.05]. There was no significant change in GRS between the two groups(p＞0.05). 2. Tmsv16-SD/R-R in LBBP group and RVSP group after surgery were lower than that before surgery (p<0.05). Tmsv16-SD/R-R in the LBBP group after surgery remained stable (P>0.05). At 18 months after surgery, Tmsv16-SD/R-R was significantly lower than that in the RVSP group [(4.27±0.67) vs (6.34±1.70), P<0.05]. 3. The QRS duration in LBBP group after surgery was significantly lower than that before surgery. And the QRS duration of the patients in the LBBP group remained stable during the 18-month follow-up (P>0.05). The QRS duration in the RVSP group after surgery had no significant change compared with that before surgery.The QRS duration in the LBBP group was significantly lower than that in the RVSP group after surgery (P＜0.05). 4. The LVEF of the LBBP group and the RVSP group remained stable after surgery, and there was no statistical difference between the two groups.
Conclusions:
As an emerging pacing method, LBBP has good postoperative contractility and can maintain good electromechanical synchronization.
Related Concept Videos
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias
01:24Cardiac Catheterization III: Left Heart Catheterization