Feasibility and stability of left bundle branch pacing in patients after prosthetic valve implantation

Guo, Ji-Ming; Li, Linlin; Xiao, Guosheng; Huang, Xinyi; Li, Qiang; Wang, Yan; Cai, Binni

doi:10.1002/clc.23413

Cited by 12 publications

(13 citation statements)

References 34 publications

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“…LBBP paced beyond the conduction block ( 12 , 15 , 26 ) is an alternative method for delivering ventricular resynchronization comparable to HBP but with stable and lower capture thresholds and a higher success rate ( Table 2 ) ( 12 , 27 , 28 ), while conventional HBP may fail to pace beyond the block site in patients of infranodal AVB ( 12 , 17 , 27 ). In addition, LBBP other than HBP provides more operational space for AVN ablation ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

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Feasibility and Outcomes of Upgrading to Left Bundle Branch Pacing in Patients With Pacing-Induced Cardiomyopathy and Infranodal Atrioventricular Block

Yue

et al. 2021

Front. Cardiovasc. Med.

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His bundle pacing (HBP) can reverse left ventricular (LV) remodeling in patients with right ventricular (RV) pacing-induced cardimyopathy (PICM) but may be unable to correct infranodal atrioventricular block (AVB). Left bundle branch pacing (LBBP) results in rapid LV activation and may be able to reliably pace beyond the site of AVB. Our study was conducted to assess the feasibility, safety, and outcomes of permanent LBBP in infranodal AVB and PICM patients. Patients with infranodal AVB and PICM who underwent LBBP for cardiac resynchronization therapy (CRT) were included. Clinical evaluation and echocardiographic and electrocardiographic assessments were recorded at baseline and follow-up. Permanent LBBP upgrade was successful in 19 of 20 patients with a median follow-up duration of 12 months. QRS duration (QRSd) increased from 139.3 ± 28.0 ms at baseline to 176.2 ± 21.4 ms (P < 0.001) with right ventricular pacing (RVP) and was shortened to 120.9 ± 15.2 ms after LBBP (P < 0.001). The mean LBBP threshold was 0.7 ± 0.3 V at 0.4 ms at implant and remained stable during follow-up. The left ventricular ejection fraction (LVEF) increased from 36.3% ± 6.5% to 51.9% ± 13.0% (P < 0.001) with left ventricular end-systolic volume (LVESV) reduced from 180.1 ± 43.5 to 136.8 ± 36.7 ml (P < 0.001) during last follow-up. LBBP paced beyond the site of block, which results in a low pacing threshold with a high success rate in infranodal AVB patients. LBBP improved LV function with stable parameters over the 12 months, making it a reasonable alternative to cardiac resynchronization pacing via a coronary sinus lead in infranodal AVB and PICM patients.

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Section: Discussionmentioning

confidence: 99%

“…LBBP is a reliable physiological pacing strategy for AVB ( 13 , 14 , 26 , 27 ) or HF patients with typical LBBB ( 16 , 28 ). Maintaining and restoring physiological LV activation is an essential prerequisite in patients with LV dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Outcomes of Upgrading to Left Bundle Branch Pacing in Patients With Pacing-Induced Cardiomyopathy and Infranodal Atrioventricular Block

Yue

et al. 2021

Front. Cardiovasc. Med.

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“…Furthermore, HBP may result in high pacing threshold in some cases ( 27 ). Guo et al ( 26 ) also described successful LBBP in four patients with TVR. However, tricuspid valve regurgitation after LBBP procedure was not evaluated in their study.…”

Section: Discussionmentioning

confidence: 96%

“…Therefore, a more distal recruitment of conduction system in LBBP may provide significant advantage in success rate compared with HBP. Guo et al ( 26 ) reported LBBP in 20 patients with PVs. In their study, LBBP was successfully achieved in four patients with TAVR with a short-term follow-up period of 10.4 ± 5.9 months.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Safety of Permanent Left Bundle Branch Pacing in Patients With Conduction Disorders Following Prosthetic Cardiac Valves

Wei

Liao

et al. 2021

Front. Cardiovasc. Med.

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Background: The feasibility and safety of left bundle branch pacing (LBBP) in patients with conduction diseases following prosthetic valves (PVs) have not been well described.Methods: Permanent LBBP was attempted in patients with PVs. Procedural success and intracardiac electrical measurements were recorded at implant. Pacing threshold, complications, and echocardiographic data were assessed at implant and follow-up visit.Results: Twenty-two consecutive patients with atrioventricular (AV) conduction disturbances (10 with AV nodal block and 12 with infranodal block) underwent LBBP. The PVs included aortic valve replacement (AVR) in six patients, mitral valve repair or replacement (MVR) with tricuspid valve ring (TVR) in four patients, AVR with TVR in one patient, AVR with MVR plus TVR in three patients, transcatheter aortic valve replacement (TAVR) in five patients, and MVR alone in three patients. LBBP succeeded in 20 of 22 (90.9%) patients. LBB potential was observed in 15 of 22 (68.2%) patients, including 10 of 15 (66.7%) patients with AVR/TAVR and five of seven (71.4%) patients without AVR/TAVR. AVR and TVR served as good anatomic landmarks for facilitating the LBBP. The final sites of LBBP were 17.9 ± 1.4 mm inferior to the AVR and 23.0 ± 3.2 mm distal and septal to the TVR. The paced QRS duration was 124.5 ± 13.8 ms, while the baseline QRS duration was 120.0 ± 32.5 ms (P = 0.346). Pacing threshold and R-wave amplitude at implant were 0.60 ± 0.16 V at 0.5 ms and 11.9 ± 5.5 mV and remained stable at the mean follow-up of 16.1 ± 10.8 months. No significant exacerbation of tricuspid valve regurgitation was observed compared to baseline.Conclusion: Permanent LBBP could be feasibly and safely obtained in the majority of patients with PVs. The location of the PV might serve as a landmark for guiding the final site of the LBBP. Stable pacing parameters were observed during the follow-up.

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“…Left bundle branch area pacing (LBBAP) is a promising physiological pacing modality which has been shown to promote better electrical and mechanical synchrony in comparison to traditional right ventricular (RV) pacing 4,5 . A few small studies have been previously published describing conduction system pacing in patients with valvular interventions, but these have combined His bundle and left bundle pacing 6–8 . The role of LBBAP alone is not well described (Table ).…”

Section: Introductionmentioning

confidence: 99%

Safety and feasibility of left bundle branch area pacing following valvular interventions: Multicenter study

Gül

Kabadi

Padala

et al. 2021

Cardiovasc electrophysiol

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Objectives To evaluate the safety and feasibility of left bundle branch area pacing (LBBAP) in patients with valvular interventions. Methods Eighty‐four patients were included in this study. All patients underwent recent surgical or percutaneous valvular interventions. LBBAP was attempted in all patients. Implant success rates, peri‐ and postprocedure electrocardiogram, pacing parameters, and complications were assessed at implant, and during follow‐up. Results LBBAP implantation was successful in 80/84 (95%) patients. Mean age was 74.1 ± 13.8 years and 56% patients were male. Prior valvular replacements included: percutaneous aortic (26), surgical aortic (36), combined surgical aortic plus mitral (6), MVR (10), tricuspid (1), and pulmonic (1). Average LVEF was 52.6 ± 11%. Majority of patients underwent LBBAP due to atrioventricular block (76%) and sinus node disease (13%). Total procedure duration was 74.1 ± 12.5 min and fluoroscopic duration was 9.7 ± 6.8 min. Pacing parameters were stable during follow‐up period of 10.0 ± 6.3 months. Pacing QRS duration was significantly narrower than baseline QRS duration (131.5 ± 31.4 ms vs. 114.3 ± 13.7 ms, p < .001, respectively). No acute complications were observed. Mean follow‐up was 10.0 ± 6.3 months (median: 8.4 months, min: 1 and max: 24 months). During follow‐up, there were three device infections and two patients had loss of LBBA capture within 1 month of implant. Conclusions LBBAP is a feasible and safe pacing modality in patients with prior interventions for valvular heart disease.

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Feasibility and stability of left bundle branch pacing in patients after prosthetic valve implantation

Cited by 12 publications

References 34 publications

Feasibility and Outcomes of Upgrading to Left Bundle Branch Pacing in Patients With Pacing-Induced Cardiomyopathy and Infranodal Atrioventricular Block

Feasibility and Outcomes of Upgrading to Left Bundle Branch Pacing in Patients With Pacing-Induced Cardiomyopathy and Infranodal Atrioventricular Block

Feasibility and Safety of Permanent Left Bundle Branch Pacing in Patients With Conduction Disorders Following Prosthetic Cardiac Valves

Safety and feasibility of left bundle branch area pacing following valvular interventions: Multicenter study

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