Resynchronization effects and clinical outcomes during left bundle branch area pacing with and without conduction
Weiwei Zhang1, Lu Chen2, Xiaohong Zhou3
1Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Clinical Cardiology
|January 4, 2023
Summary
Left bundle branch area pacing (LBBAP), including left bundle branch pacing (LBBP), offers superior resynchronization and left ventricular ejection fraction (LVEF) improvement compared to left ventricular septal myocardial pacing (LVSP) in heart failure patients.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Left bundle branch area pacing (LBBAP) encompasses left bundle branch pacing (LBBP) and left ventricular septal myocardial pacing (LVSP).
- These pacing techniques are explored for patients with heart failure (HF) indicated for cardiac resynchronization therapy (CRT).
Purpose of the Study:
- To evaluate the resynchronization efficacy and clinical outcomes of LBBAP in HF patients eligible for CRT.
- To compare the effects of LBBP versus LVSP on electrical and mechanical synchrony and LVEF.
Main Methods:
- LBBAP was successfully implanted in 29 HF patients, divided into LBBP (N=15) and LVSP (N=14) groups.
- Pacing strategies included optimized LBBP, LVSP, or LVSP combined with left ventricular pacing (LVSP-LVP).
- Left ventricular (LV) electrical and mechanical synchrony, along with clinical outcomes, were assessed post-implantation.
Main Results:
- Left ventricular activation during LBBP was significantly faster than during LVSP.
- LBBP demonstrated shorter stimulus-to-peak LV activation time (Stim-LVAT) and improved LV mechanical synchrony (TSI-SD) compared to LVSP.
- After a median follow-up of 17 months, the LBBP group showed significantly greater improvement in LVEF (26.0%) than the LVSP group (6.0%).
Conclusions:
- Left bundle branch pacing (LBBP) facilitates faster LV activation compared to LVSP.
- LBBP provides superior electrical and mechanical resynchronization in HF patients.
- LBBP leads to better LVEF improvement than LVSP in HF patients undergoing CRT.
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