Left bundle branch area pacing prevents pacing induced cardiomyopathy in long‐term observation

Abstract

Background: Left bundle branch area pacing (LBBAP) is one of the methods to deliver conduction system pacing which potentially avoids the negative impact of conventional right ventricular pacing.Objective: To assess echocardiographic outcomes in a long-term observation in patients with LBBAP implemented for bradyarrhythmia indications. Methods and Results:A total of 151 patients with symptomatic bradycardia and LBBAP pacemaker implanted, were prospectively included in the study. Subjects with left bundle branch block and CRT indications (n = 29), ventricular pacing burden <40%(n = 11), and loss of LBBAP (n = 10) were excluded from further analysis. At baseline and the last follow-up visit, echocardiography with global longitudinal strain (GLS) assessment, 12-lead ECG, pacemaker interrogation, and blood level of NT-proBNP were performed. The median follow-up period was 23 months (15.5-28). None of the analyzed patients fulfilled the criteria for pacing induced cardiomyopathy (PICM).Improvement in left ventricular ejection fraction (LVEF) and GLS was observed in patients with LVEF <50% at baseline (n = 39): 41.4 ± 9.2% versus 45.6 ± 9.9%, and 12.9 ± 3.6% versus 15.5 ± 3.7%, respectively. In the subgroup with preserved EF (n = 62), LVEF and GLS remained stable at follow-up: 59.3 ± 5.5% versus 60 ± 5.5%, and 19 ± 3.9% versus 19.4 ± 3.8%, respectively. Conclusion:LBBAP prevents PICM in patients with preserved LVEF and improves left ventricle function in subjects with depressed LVEF. LBBAP might be the preferred pacing modality for bradyarrhythmia indications.

Detailed One-Year Follow-Up in Left Bundle Branch Area Pacing: Echocardiography, Natriuretic Peptide, Electrical Parameters and Complications

“…Bednarek et al [ 10 ] showed that LVEF increased in bradycardia patients with baseline LVEF below 50%, while it was stable in individuals with preserved LVEF, and they concluded that LBBAP prevents PICM in patients with preserved LVEF and improves left ventricle function in subjects with depressed LVEF. Our results are, in general, consistent with these findings.…”

“…The mechanism underlying these results is fast activation of the left ventricle by left bundle branch (LBB) fibres or via quick capture of the left side of the septal myocardium. This may not only prevent the development of pacing-induced cardiomyopathy [ 10 , 11 ], but may also improve ventricular synchrony, restoring impaired conduction in patients with left bundle branch block (LBBB). Individuals with right bundle branch block (RBBB) may benefit from a reduction in right ventricular activation delay due to the capture of the septal myocardium.…”

The Effect of Medical Therapy on Reducing the Risk of Pacing Induced Cardiomyopathy

“…Long term observational trials have demonstrated that left bundle area pacing preserves EF. 16 Small, retrospective studies have also show benefit in improving EF in patients who have already developed PICM. 17 Although prospective randomized trials are still needed, left bundle area pacing is becoming standard practice.…”

The impact of operator experience on the success rate, time aspects, and electrocardiographic features in left bundle branch area pacing

“…Like us, Jastrzębski et al [5] concluded that there is no influence of operator experience on LBBP and LVSP proportions. The high success rate of LBBAP is encouraging for wide application of this method, especially when the recent study of Bednarek et al [11] showed that LBBAP could prevent pacing-induced cardiomyopathy.…”