Left bundle branch area pacing prevents pacing induced cardiomyopathy in long-term observation
Agnieszka Bednarek1, Grzegorz Kiełbasa1, Paweł Moskal1
1First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland.
Insights
Left bundle branch area pacing (LBBAP) avoids pacing-induced cardiomyopathy and improves heart function in bradyarrhythmia patients. This study suggests LBBAP may be a preferred pacing method for these conditions.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- Conventional right ventricular pacing can have negative impacts.
- Left bundle branch area pacing (LBBAP) is an alternative conduction system pacing method.
- LBBAP aims to mitigate adverse effects associated with traditional pacing.
Purpose of the Study:
- To evaluate long-term echocardiographic outcomes in patients receiving LBBAP for bradyarrhythmia.
- To assess the impact of LBBAP on cardiac function and strain.
- To determine if LBBAP prevents pacing-induced cardiomyopathy (PICM).
Main Methods:
- Prospective study of 151 patients with symptomatic bradycardia and LBBAP.
- Exclusion criteria included left bundle branch block with CRT indications, low ventricular pacing burden, and LBBAP loss.
- Echocardiography with GLS, ECG, pacemaker interrogation, and NT-proBNP levels were assessed at baseline and follow-up (median 23 months).
Main Results:
- No patients developed PICM.
- In patients with baseline LVEF <50% (n=39), LVEF improved from 41.4% to 45.6% and GLS from 12.9% to 15.5%.
- In patients with preserved LVEF (n=62), LVEF and GLS remained stable.
Conclusions:
- LBBAP effectively prevents PICM in patients with preserved LVEF.
- LBBAP improves left ventricular function in patients with depressed LVEF.
- LBBAP is a potentially superior pacing modality for bradyarrhythmia indications.
Background:
Left bundle branch area pacing (LBBAP) is one of the methods to deliver conduction system pacing which potentially avoids the negative impact of conventional right ventricular pacing.
Objective:
To assess echocardiographic outcomes in a long-term observation in patients with LBBAP implemented for bradyarrhythmia indications.
Methods And Results:
A total of 151 patients with symptomatic bradycardia and LBBAP pacemaker implanted, were prospectively included in the study. Subjects with left bundle branch block and CRT indications (n = 29), ventricular pacing burden <40% (n = 11), and loss of LBBAP (n = 10) were excluded from further analysis. At baseline and the last follow-up visit, echocardiography with global longitudinal strain (GLS) assessment, 12-lead ECG, pacemaker interrogation, and blood level of NT-proBNP were performed. The median follow-up period was 23 months (15.5-28). None of the analyzed patients fulfilled the criteria for pacing induced cardiomyopathy (PICM). Improvement in left ventricular ejection fraction (LVEF) and GLS was observed in patients with LVEF <50% at baseline (n = 39): 41.4 ± 9.2% versus 45.6 ± 9.9%, and 12.9 ± 3.6% versus 15.5 ± 3.7%, respectively. In the subgroup with preserved EF (n = 62), LVEF and GLS remained stable at follow-up: 59.3 ± 5.5% versus 60 ± 5.5%, and 19 ± 3.9% versus 19.4 ± 3.8%, respectively.
Conclusion:
LBBAP prevents PICM in patients with preserved LVEF and improves left ventricle function in subjects with depressed LVEF. LBBAP might be the preferred pacing modality for bradyarrhythmia indications.
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