Feasibility, safety and outcomes of upgrading to left bundle branch pacing in patients with right ventricular pacing induced cardiomyopathy

Abstract

Background Right ventricular pacing (RVP) induces abnormal electrical activation and asynchronous ventricular contraction and leads to pacing induced cardiomyopathy (PICM) in 10%–20% of patients. Cardiac resynchronization therapy (CRT) utilizing biventricular pacing (BVP) is the recommended treatment. Left bundle branch pacing (LBBP) is a novel physiological pacing technique which may serve as an alternative to CRT. This study assessed feasibility and outcomes of LBBP delivered CRT in patients with PICM. Methods Total 20 consecutive patients with PICM who received an upgrade of their pacemaker to LBBP were prospectively studied. Acute success rate, complications, functional and echocardiographic response, and hospitalization for heart failure within 6 months from implantation were evaluated. Results LBBP was successfully delivered in all patients. Median duration of RVP before upgrade to LBBP was 3.8 years and the RVP was 99%. LBBP resulted in significant QRS narrowing (from 193 ± 18 ms to 130 ± 17 ms [p < .001]), improvement in LVEF (from 32% ± 6 % to 47% ± 8% [p < .001]) and NYHA class (from 2.8 ± 0.4 to 1.4 ± 0.5 [p < .001]) at 6 months. No LBBP‐related complications occurred. No patients were hospitalized for heart failure or died. Conclusion LBBP is feasible and safe in delivering CRT in PICM. Preliminary analyses demonstrated significant electrical resynchronization and favorable improvement in LV function and NYHA functional class at short term follow‐up. Data needs to be validated in large randomized controlled trials.

Reverse left ventricular remodeling with left bundle branch area pacing in heart failure patients with dyssynchrony: Systematic Review and Meta-Analysis

“…The remaining 20 studies were later excluded due to lack of a target population or failure to report outcomes of interest. As a result, the final analysis included 15 observational cohort studies [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] with 772 individuals with HFrEF who underwent LBBAP implantation. The included articles were classified into 2 categories: patients with PICM (4 articles, 62 patients) [7][8][9][10] and patients without PICM (11 articles, 710 patients) [11][12][13][14][15][16][17][18][19][20][21] .…”

“…According to the literature review [7][8][9][10] (Table 1 ), the diagnosis of PICM is made in the presence of a [?] 10% decrease in LVEF after chronic RV pacing with resultant LVEF [?]…”

“…Thus, the benefits of LBBAP, such as improvement in clinical and echocardiographic findings and fewer complications, have gained interest as a potential alternative to BVP [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . However, the data to support these notions remain controversial.…”

Recruitment of the cardiac conduction system for optimal resynchronization therapy in failing heart

“…Permanent LBBAP was successfully achieved in 93%–100% of patients with PICM and could also be performed safely in those with intranodal blocks. After the follow-up time ranging from 6 to 12 months ( Qian et al, 2021 ; Rademakers et al, 2022 ), LBBAP could result in significant narrowing of QRSd, and improvement of LVEF and NYHA function with no observations of upgrade-related complications. But clinical observations comparing the efficacy of BVP and LBBAP for CRT upgradation are still lacking.…”

Left bundle branch area pacing in mildly reduced heart failure: A systematic literature review and meta-analysis

“…The title and abstract of the articles were screened, and 566 were excluded due to being editorials/review articles, case reports/letters, having no relevant outcome, and not being in English. The remaining 128 articles underwent full-text review, and 120 were excluded for not meeting the inclusion criteria; finally, eight studies [25][26][27][28][29][30][31][32] were retrieved (Figure 1 and Table 1).…”