The initial experience of left bundle branch area pacing in patients with hypertrophic cardiomyopathy
Haojie Zhu1, Zhao Wang1, Xiaofei Li1
1Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Left bundle branch area pacing (LBBAP) is feasible in some hypertrophic cardiomyopathy (HCM) patients, but success rates are limited by septal thickness and fibrosis. Careful consideration of pacing strategies is advised for HCM patients.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- Hypertrophic cardiomyopathy (HCM) can necessitate ventricular pacing.
- The feasibility of left bundle branch area pacing (LBBAP) in HCM patients is not well-established.
Purpose of the Study:
- To investigate the feasibility and efficacy of LBBAP in patients with HCM requiring ventricular pacing.
Main Methods:
- Prospective collection of clinical, echocardiographic, and pacing data from 11 HCM patients undergoing LBBAP between November 2018 and September 2021.
- Analysis of success rates, pacing parameters, and procedural complications.
Main Results:
- LBBAP was successful in 36.4% (4/11) of HCM patients.
- Failed LBBAP was associated with thicker interventricular septum and greater myocardial fibrosis.
- Successful LBBAP resulted in narrower QRS duration compared to failed attempts.
Conclusions:
- LBBAP success in HCM is limited by anatomical factors like septal thickness and myocardial fibrosis.
- Pacing strategies in HCM patients require careful consideration due to these challenges.
Purpose:
Whether left bundle branch area pacing (LBBAP) could be achieved in patients with hypertrophic cardiomyopathy (HCM) requiring ventricular pacing remains unknown. The present study aimed to investigate the feasibility and effect of LBBAP in HCM.
Methods:
Patients with HCM who underwent LBBAP were recruited from November 2018 to September 2021. Clinical characteristics, echocardiographic, and pacing parameters were prospectively collected at baseline and during follow-up.
Results:
Eleven consecutive HCM patients who attempted LBBAP were included (mean age 64.0 ± 8.7 years, female 45.5%, mean interventricular septum 16.7 mm). The success rate of LBBAP was 36.4% (4/11) and the reason for failed LBBAP in other seven HCM patients was the inability to screw the lead into the deep septum or capture the left bundle branch. Patients with successful LBBAP had significantly narrower QRS duration than those with failed cases (118.0 ± 3.7 ms vs. 140.9 ± 9.4 ms, p = .01) while the capture thresholds, sensing amplitudes, and pacing impedances were similar. Successful cases presented with less positive late gadolinium enhancement (25.0% vs. 71.4%, p = .02) and thinner interventricular septum thickness (14.5 ± 1.0 mm vs. 18.0 ± 2.5 mm, p = .02) compared with failed cases. Pacing parameters remained stable and no procedure-related complications occurred during a mean follow-up of 8.9 ± 7.3 months.
Conclusion:
LBBAP may be successfully achieved in less than half of HCM patients due to thick interventricular septum and heavy burden of myocardial fibrosis. Pacing strategies should be cautiously considered in patients with HCM.
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