Is conduction system pacing improving cardiac performance in patients with right bundle branch block and heart
Jia Jing-Jing1, Sun Xi-Xia1, Li Tian-Zhu1
1Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Insights
Conduction system pacing (CSP) is a safe and effective treatment for patients with right bundle branch block and heart failure. This study shows significant improvements in cardiac function and symptoms, especially in those with severely reduced left ventricular ejection fraction.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Right bundle branch block (RBBB) and heart failure (HF) often coexist, leading to complex management challenges.
- Ventricular pacing in RBBB patients can exacerbate or induce left ventricular dysfunction.
- Conduction system pacing (CSP) offers a potential alternative to traditional pacing by directly targeting the heart's natural conduction system.
Purpose of the Study:
- To assess the feasibility and safety of CSP in patients diagnosed with RBBB and HF.
- To evaluate the impact of CSP on cardiac function and clinical outcomes in this patient population.
Main Methods:
- A retrospective study of patients with HF and RBBB undergoing CSP between 2018 and 2023.
- Inclusion criteria: ventricular pacing >40% and pre-existing RBBB.
- Data collection included echocardiographic and electrocardiographic parameters, with a minimum 2-year follow-up.
Main Results:
- CSP was successfully performed in 88.63% of patients (n=78).
- Significant improvements observed in QRS duration, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter, and NYHA functional class (p<0.05).
- Patients with baseline LVEF ≤35% showed marked LVEF improvement (p=0.001); LVEF and ΔQRS were independent predictors of response.
Conclusions:
- CSP is a safe and effective pacing strategy for patients with RBBB and HF.
- CSP leads to significant improvements in cardiac performance and functional status.
- Particular benefit observed in patients with severely reduced baseline LVEF, highlighting CSP as a promising therapeutic option.
Objective:
The aim of this study was to evaluate the feasibility and safety of conduction system pacing (CSP) in patients with right bundle branch block (RBBB) and heart failure (HF).
Methods:
This retrospective study included all the patients with HF and a ventricular pacing frequency of more than 40% who underwent CSP between 2018 and 2023, with all enrolled patients presenting RBBB prior to the procedure. Clinical data, including echocardiographic and electrocardiographic findings, were collected before and after the procedure, with a minimum follow-up duration of 2 years.
Results:
CSP was successfully performed in 78 patients (78/88, 88.63%), comprising 13 patients (13/78, 16.67%) with His-bundle pacing (HBP) and 65 patients (65/78, 83.33%) with left bundle branch pacing (LBBP). Significant improvements were observed in QRS duration (148.06 ± 17.91 ms vs. 121.87 ± 14.47 ms, p < 0.001), left ventricular ejection fraction (LVEF) (43.79% ± 11.71% vs. 46.94% ± 10.06%, p = 0.020), left ventricular end-diastolic diameter (LVEDD) (54.15 ± 7.67 mm vs. 52.71 ± 7.67 mm, = 0.016), and the New York Heart Association (NYHA) functional class (2.97 ± 0.68 vs. 1.63 ± 1.08, p = 0.001). No significant change was noted in the left atrial diameter (LAD) (44.72 ± 8.07 mm vs. 43.86 ± 8.42 mm, p = 0.114). Subgroup analysis revealed that a marked LVEF improvement was observed in patients with baseline LVEF ≤35% (30.05% ± 2.76% vs. 41.42% ± 11.61%, p = 0.001). Logistic regression analysis revealed that LVEF (OR = 0.112, 95% CI: 0.011-0.839, and p = 0.001) and ΔQRS (OR = 1.449, 95% CI: 1.292-2.445, and p = 0.021) were independent predictors of echocardiographic response.
Conclusion:
CSP is safe and effective for patients with RBBB and HF, with particularly notable improvements in cardiac performance among those with severely reduced LVEF.
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