His bundle pacing versus left bundle branch pacing on ventricular function in atrial fibrillation patients referred
Yang Ye1, Bo Gao1,2, Yuan Lv1,3
1Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
Insights
His bundle pacing and left bundle branch pacing both improve heart failure symptoms in atrial fibrillation patients. Left bundle branch pacing showed similar effects on left ventricular function, while His bundle pacing improved right ventricular function.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- Physiologic pacing with His bundle pacing (HBP) and left bundle branch pacing (LBBP) maintains left ventricular synchrony.
- Both HBP and LBBP can improve heart failure (HF) symptoms in patients with atrial fibrillation (AF).
- This study compares ventricular function and lead parameters between HBP and LBBP in AF patients.
Purpose of the Study:
- To compare the intra-patient effects of HBP and LBBP on ventricular function and remodeling.
- To assess lead parameters for both pacing modalities in AF patients.
- To evaluate intermediate-term outcomes of HBP versus LBBP in AF patients undergoing AVN ablation.
Main Methods:
- A randomized crossover study comparing HBP and LBBP in AF patients with uncontrolled ventricular rates.
- Echocardiography, NYHA classification, and quality-of-life assessments were performed at baseline and 6-month follow-ups.
- Key parameters assessed included LVESV, LVEF, and RV function (TAPSE).
Main Results:
- Twenty-eight patients were enrolled, with successful implantation of both HBP and LBBP leads.
- Both pacing modalities improved left ventricular end-systolic volume (LVESV).
- Left ventricular ejection fraction (LVEF) improved in patients with baseline LVEF < 50%.
- His bundle pacing improved tricuspid annular plane systolic excursion (TAPSE), whereas LBBP did not.
Conclusions:
- Left bundle branch pacing demonstrated equivalent effects on left ventricular function and remodeling compared to His bundle pacing.
- His bundle pacing showed superior improvement in right ventricular function (TAPSE).
- HBP may be preferred for patients with reduced baseline TAPSE, while LBBP offers stable parameters for rate control in AF.
Background:
His bundle pacing (HBP) and left bundle branch pacing (LBBP) both provide physiologic pacing which maintain left ventricular synchrony. They both improve heart failure (HF) symptoms in atrial fibrillation (AF) patients. We aimed to assess the intra-patient comparison of ventricular function and remodeling as well as leads parameters corresponding to two pacing modalities in AF patients referred for pacing in intermediate term.
Methods:
Uncontrolled tachycardia AF patients with both leads implantation successfully were randomized to either modality. Echocardiographic measurements, New York Heart Association (NYHA) classification, quality-of-life assessments and leads parameters were obtained at baseline and at each 6-month follow up. Left ventricular function including the left ventricular endo-systolic volume (LVESV), left ventricular ejection fraction (LVEF) and right ventricular (RV) function quantified by tricuspid annular plane systolic excursion (TAPSE) were all assessed.
Results:
Consecutively twenty-eight patients implanted with both HBP and LBBP leads successfully were enrolled (69.1 ± 8.1 years, 53.6% male, LVEF 59.2% ± 13.7%). The LVESV was improved by both pacing modalities in all patients (n = 23) and the LVEF was improved in patients with baseline LVEF at less than 50% (n = 6). The TAPSE was improved by HBP but not LBBP (n = 23).
Conclusion:
In this crossover comparison between HBP and LBBP, LBBP was found to have an equivalent effect on LV function and remodeling but better and more stable parameters in AF patients with uncontrolled ventricular rates referred for atrioventricular node (AVN) ablation. HBP could be preferred in patients with reduced TAPSE at baseline rather than LBBP.
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