Assessing cardiac mechanical dyssynchrony in left bundle branch area pacing and right ventricular septal pacing using myocardial perfusion scintigraphy in the acute phase of pacemaker implantation

Abstract

Introduction: Left bundle branch area pacing (LBBAP) has recently been reported to be a new, clinically feasible and safe physiological pacing strategy. The present study aims to investigate the usefulness of LBBAP in reducing mechanical dyssynchrony compared with right ventricular septal pacing (RVSP). Methods and Results: A total of 39 LBBAP patients, 42 RVSP patients, and 93 healthy control participants were retrospectively evaluated. We compared phase analysis-(bandwidth, phase standard deviation [PSD], entropy) and regional wall motion analysis parameters. Wall motion analysis parameters included the time to the end-systolic frame (TES) assessed using single-photon emission computed tomography analysis. The maximum differences between segmental TES (MDTES), the standard deviation of TES (SDTES), and theTES difference between the lateral and septal segments (DTES-LS) were obtained. All phase analysis parameters were significantly smaller in the LBBAP group

Comparison of the left ventricular dyssynchrony between stylet-driven and lumen-less lead technique in left bundle branch area pacing using myocardial perfusion scintigraphy

“…Therefore, we used scintigraphy as the evaluation modality for LV synchrony in LBBAP. We previously reported that LBBAP using LLLs reduced mechanical dyssynchrony compared to RVSP and comparable to healthy control participants using myocardial perfusion scintigraphy ( 18 ). This indicates that LBBAP using SDLs may also reduce LV mechanical dyssynchrony compared with RVSP.…”

“…LBBAP is a new conduction system pacing method to avoid non-physiological harmful RV pacing. Some reports revealed that LBBAP reduces electrical and dyssynchrony compared to RVP ( 18 , 19 ). Furthermore, the effectiveness of LBBAP in narrowing paced QRS duration and improving LVEF is comparable to that of HBP and biventricular pacing ( 7 , 8 ).…”

“…As previously reported, using a phase and regional wall motion analysis tool (cardioREPO, FUJIFILM RI Pharma, Tokyo, Japan, in collaboration with EXINI Diagnostics, Lund, Sweden) after gated SPECT acquisition we calculated the LV volume, LV systolic and diastolic function, such as end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF), the peak fill factor (PFR) and 1/3 mean filling rate (MFR) ( 15 , 16 ). Similarly, we calculated the phase analysis parameters such as the 95% width of the histogram or bandwidth (phase bandwidth), the phase standard deviation (PSD) and entropy, and regional wall motion analysis parameters, as we previously reported ( 17 , 18 ). The time to the end-systolic frame (TES) was calculated in regional wall motion analysis using SPECT.…”

“…The time to the end-systolic frame (TES) was calculated in regional wall motion analysis using SPECT. We also evaluated the maximum differences between segmental TES (MDTES), the standard deviation of TES (SDTES), and the difference in the TES between the lateral wall and septum (DTES-LS) using cardioREPO ( 18 ). LV synchrony was compared using all phase analysis and regional wall motion analysis parameters between both groups.…”

Spatial Dispersion of Activation and Repolarization Times Associated with Different Cardiac Pacing Modes

“…Different cardiac pacing strategies are currently being used in patients with an indication for permanent pacemaker. Since electrical dyssynchrony has been shown to be associated with heart failure and increased mortality [11], it is important to determine which modality of pacing leads to an electrical behavior closest to the physiological one in patients with normal conduction (narrow QRS).…”