Left bundle branch area pacing improves right ventricular function and synchrony
Agnieszka Bednarek1, Grzegorz Kiełbasa1, Paweł Moskal2
1First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland; Cardiology, Interventional Cardiac Electrophysiology and Arterial Hypertension Clinical Department, University Hospital, Krakow, Poland.
Heart Rhythm
|May 16, 2024
Summary
Left bundle branch area pacing (LBBAP) improves right ventricular (RV) function, particularly in patients with baseline septal abnormalities. However, basal LBBAP placement may be linked to worsening tricuspid regurgitation (TR).
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- The long-term effects of left bundle branch area pacing (LBBAP) on right ventricular (RV) function and tricuspid regurgitation (TR) are not well understood.
- Assessing these impacts is crucial for optimizing pacing strategies.
Purpose of the Study:
- To evaluate the long-term effects of LBBAP on RV performance and TR.
- To identify predictors of RV function improvement and TR progression after LBBAP.
Main Methods:
- RV function assessed via RV free wall strain, tricuspid annular plane systolic excursion, fractional area change, and lateral tricuspid annulus systolic velocity.
- RV motion patterns evaluated by presence of reverse septal flash (RSF) and basal bulge (BB).
- Lead-TV distance measured to assess lead proximity to the tricuspid annulus.
Main Results:
- In 122 patients (mean age 76.5 years) with a median follow-up of 21 months, RV free wall strain significantly improved post-LBBAP.
- Left ventricular ejection fraction predicted improved RV function.
- RSF and BB resolved in most patients, with greater RV function improvement in those with baseline RSF.
- No overall TR deterioration, but shorter lead-TV distance (<24.5 mm) correlated with TR progression.
Conclusions:
- LBBAP demonstrates a beneficial effect on RV function.
- Basal LBBAP positioning may be associated with an increased risk of TR worsening.
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