Impact on right ventricular performance in patients undergoing permanent pacemaker implantation: Left bundle branch pacing versus right ventricular septum pacing

Abstract

Background The novel method of left bundle branch pacing (LBBP) has been reported to achieve better electrical and mechanical synchrony in the left ventricle than conventional right ventricular pacing (RVP). However, its effects on right ventricle (RV) performance are still unknown. Methods Consecutive patients undergoing dual‐chamber pacemaker (PM) implantation for sick sinus syndrome (SSS) with normal cardiac function and a narrow QRS complex were recruited for the study. The pacing characteristics and echocardiogram parameters were measured to evaluate RV function, interventricular and RV synchrony, and were compared between ventricular pacing‐on and native‐conduction modes. Results A total of 84 patients diagnosed with SSS and an indication for pacing therapy were enrolled. Forty‐two patients (50%; mean age 65.50 ± 9.30 years; 35% male) underwent successful LBBP and 42 patients (50%; mean age 69.26 ± 10.08 years; 33% male) RVSP, respectively. Baseline characteristics were similar between the two groups. We found no significant differences in RV function [RV‐FAC (Fractional Area Change)%, 47.13 ± 5.69 versus 48.60 ± 5.83, p = .069; Endo‐GLS (Global Longitudinal Strain)%, −28.88 ± 4.94 versus −29.82 ± 5.35, p = .114; Myo‐GLS%, −25.72 ± 4.75 versus −25.72 ± 5.21, p = .559; Free Wall St%, 27.40 ± 8.03 versus −28.71 ± 7.34, p = .304] between the native‐conduction and LBBP capture modes, while the RVSP capture mode was associated with a significant reduction in the above parameters compared with the native‐conduction mode (p < .0001). The interventricular synchrony in the LBBP group was also superior to the RVSP group significantly. Conclusion LBBP is a pacing technique that seems to associate with a positive and protective impact on RV performance.

Comparison between left bundle branch area pacing and right ventricular pacing: ventricular electromechanical synchrony and risk of atrial high-rate episodes

“…Patients were divided according to the ventricular pacing sites: the LBBAP group and the RVP group (including the RVA group and the RVS group). LBBAP was achieved if the pacing morphology of the QRS complex showed an RBBB pattern and fulfilled either of the following criteria ( 11 – 13 ): (i) confirmation of recording LBB potential; (ii) the stimulus to left ventricular activation time (Stim-LVAT) shortening abruptly with increasing output or remaining shortest and constant (<90 ms) at either low or high outputs. The initial pacing setting utilized in this study was bipolar pacing with output of 3.5 V/0.42 ms (automatic adjustment of pacing output 100 days after the procedure), DDD mode with a base rate of 60 bpm, and the initial atrioventricular (AV) delay was set at 150 ms-sensed AV delay and 180 ms-paced AV delay.…”