[»Left bundle branch area pacing«]
Alice David1, Amar Taha2, Andreas Martinsson3
1doktorand, överläkare, VO kardiologi, Sahlgrenska universitetssjukhuset, Göteborg.
Insights
Left bundle branch area pacing (LBBAP) offers a more physiological alternative to traditional right ventricular pacing, potentially reducing the risk of pacing-induced cardiomyopathy. LBBAP promotes synchronous ventricular activation, unlike RV pacing which can cause dyssynchronous contraction.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Pacing-induced cardiomyopathy (PIC) is a significant cause of morbidity and mortality, often linked to right ventricular (RV) pacing.
- RV pacing can lead to delayed electrical activation and dyssynchronous ventricular contraction, increasing PIC risk.
Purpose of the Study:
- To evaluate Left Bundle Branch Area Pacing (LBBAP) as a potentially safer alternative to RV pacing for preventing PIC.
- To highlight the physiological benefits of LBBAP in achieving synchronous ventricular activation.
Main Methods:
- LBBAP involves implanting a lead deep in the septum to capture the left bundle branch, enabling physiological left ventricular activation.
- Comparison of ventricular activation times and contraction synchrony between LBBAP and RV pacing.
Main Results:
- LBBAP demonstrates shorter ventricular activation times and reduced dyssynchronous contraction compared to RV pacing.
- Long-term electrical parameters of LBBAP are comparable to those of RV leads.
Conclusions:
- LBBAP offers a promising approach to cardiac pacing with a potentially lower risk of pacing-induced cardiomyopathy.
- Further randomized trials are ongoing to compare LBBAP with RV and biventricular pacing.
Abstract:
Pacing-induced cardiomyopathy (PIC) is a condition that leads to increased morbidity and mortality. Unfortunately, it is not uncommon after implantation of a pacemaker with a right ventricular lead. Right ventricular pacing creates a delayed electrical activation, leading to dyssynchronous contraction, and it is a known risk factor for PIC. Left bundle branch area pacing (LBBAP) is a form of pacing that delivers a physiological activation of the left ventricle. The lead is implanted deep in the septum and captures the left bundle branch of the conduction system. This allows for a synchronous electrical activation of the ventricles. LBBAP has shorter ventricular activation time and less dyssynchronous contraction compared to right ventricular pacing. Recently, studies have shown that the long-term electrical parameters are comparable to right ventricular leads. Randomized trials are underway to compare LBBAP with right ventricular pacing and biventricular pacing.
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