Left bundle branch area pacing is superior to right ventricular septum pacing concerning depolarization‐repolarization reserve

Wang, Jingfeng; Liang, Yixiu; Wang, Wei; Chen, Xueying; Bai, Jing; Chen, Haiyan; Su, Yangang; Chen, Ruizhen; Ge, Junbo

doi:10.1111/jce.14295

Cited by 53 publications

(49 citation statements)

References 23 publications

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“…The present study has confirmed the safety and feasibility of LBBP with a success rate of 87.9%, which is identical to previous studies showing the LBBP success rate is 80.5% to 92.4% 20,21 . The surgery failed in four patients, the reasons were as follows: in two cases, when removing the C315 sheath, the 3830 lead was pulled which dislocated the lead.…”

Section: Discussionsupporting

confidence: 90%

Clinical outcomes of left bundle branch pacing compared to right ventricular apical pacing in patients with atrioventricular block

Zhang

Guo

Tao

et al. 2021

Clinical Cardiology

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Background Left bundle branch pacing (LBBP) can produce near normalization of QRS duration. This has recently emerged as alternative technique to right ventricular pacing and His bundle pacing. Hypothesis The purpose of this study is to evaluate clinical outcomes of LBBP compared to right ventricular apical pacing (RVAP). Methods A total of 70 AVB patients with indications for ventricular pacing were retrospectively studied. LBBP was attempted in 33 patients, classified as LBBP group. The other patients were classified as RVAP group. Pacing parameters, electrocardiogram and echocardiogram characteristics, heart failure hospitalization (HFH), and atrial fibrillation (AF) were evaluated perioperatively and at follow‐ups. Patients were followed in the device clinic for a minimum of 12 months and up to 24 months at a 3–6 monthly interval. Results LBBP was successful in 29 of 33(87.9%) patients while all 37 of the remaining patients successfully underwent RVAP. Paced QRS duration was significantly narrower in the LBBP group compare to RVAP(110.75 ± 6.77 ms vs. 154.29 ± 6.96 ms, p = .000) at implantation, and the difference persisted during follow‐ups. Pacing thresholds (at implantation: 0.68 ± 0.22 V in the LBBP group and 0.73 ± 0.23 V in the RVAP group, p = .620) remained low and stable during follow‐ups. The cardiac function in the LBBP group remained stable during follow‐ups (LVEF%:55.08 ± 4.32 pre‐operation and 54.17 ± 4.34 at the end of follow‐up, p = .609), and better than RVAP group (LVEF%: 54.17 ± 4.34 vs. 50.14 ± 2.14, p = .005). Less HFH was observed in the LBBP group (2/29,6.89%) compared to RVAP group (10/37,27.03%). Conclusions The present investigation demonstrates the safety and feasibility of LBBP that produces narrower paced QRS duration than RVAP. LBBP is associated with reduction in the occurrence of pacing‐induced left ventricular dysfunction and HFH compared to RVAP in patients requiring permanent pacemakers.

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Section: Discussionsupporting

confidence: 90%

Clinical outcomes of left bundle branch pacing compared to right ventricular apical pacing in patients with atrioventricular block

Zhang

Guo

Tao

et al. 2021

Clinical Cardiology

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“…The previous studies have shown that the damage caused by traditional RVP is not clinically significant 15 . Different from the traditional RVP, the ventricular lead of LBBAP needs to penetrate into the interventricular septum to reach the left ventricular endocardium 16 . The ventricular lead of LBBAP into the myocardium is much deeper than that of RVP, and it needs more attempts to succeed, which we think is the main cause of myocardial damage.…”

Section: Discussionmentioning

confidence: 99%

Quantification of Acute Myocardial Damage Secondary to Implantation of Electrodes for the Left Bundle Branch Area Pacing

Chen

et al. 2021

RIC

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Background: Different from the traditional right ventricular pacing, the left bundle branch area pacing (LBBAP) is accomplished with deeper lead implantation and more attempts. However, myocardial damage is unclear in LBBAP. Objective: The objective of the study was to observe the change of troponin T and explore possible factors associated with greater myocardial damage in LBBAP. Methods: Patients with an indication for pacemaker implantation underwent attempts for LBBAP by transventricular septal method. Levels of troponin T were determined before operation, 12 h and 1 week after the operation. Parameters of intraoperation and follow-up were recorded and analyzed. Results: In total, successful LBBAP was achieved in 126 patients. The levels of troponin T increased significantly at 12 h after the operation compared with those before operation (96.45 ± 11.07 [69.06] vs. 16.59 ± 1.84 [11.92] ng/L, p < 0.001), while there were no significant differences between pre-and post-operative levels at 1 week. Correlation and regression analysis showed that only the number of attempts was an independent factor related to the change of troponin T. During 1 year of follow-up, LBBAP was safe and feasible with few complications. Conclusions: Myocardial damage of LBBAP was clinically significant. The number of attempts was an independent factor related to the myocardial damage. (REV INVEST CLIN. [AHEAD OF PRINT]

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“…Of the 530 published cases in literature, 6 (1.1%) lead dislodgements (one intraoperative, three within 24 h, one at 2 months, and one at 4 months) and 9 (1.7%) septal perforations (eight intraoperative and one at 1 month) have been identified (4,5,(15)(16)(17). In the present study, two cases of lead dislodgement were identified by the high threshold, low impedance, and X-ray film at the 1-month follow-up.…”

Section: Lead Dislodgement and Septum Perforationmentioning

confidence: 99%

Procedure-Related Complications of Left Bundle Branch Pacing: A Single-Center Experience

Chen

Wei

Bai

et al. 2021

Front. Cardiovasc. Med.

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Background: Although left bundle branch pacing (LBBP) has emerged as a novel physiological pacing strategy with a low and stable threshold, its safety has not been well-documented. In the present study, we included all the patients with procedure-related complications at our centre to estimate these LBBP cases with unique complications.Methods: We enrolled 612 consecutive patients who received the procedure in Zhongshan Hospital, Fudan University, between January 2018 and July 2020. Regular follow-ups were conducted (at 1, 3, and 6 months in the first year and every 6–12 months from the second year), and the clinical data of the patients with complications were collected and analyzed.Results: With a mean follow-up period of 12.32 ± 5.21 months, procedure-related complications were observed in 10 patients (1.63%) that included two postoperative septum perforations (2/612, 0.33%), two postoperative lead dislodgements (2/612, 0.33%), four intraoperative septum injuries (4/612, 0.65%), and two intraoperative lead fractures (2/612, 0.33%). Pacing parameters were stable during follow-up, and no major complications were observed after lead repositioning in the cases of septum perforation and lead dislodgement.Conclusion: The incidence of procedure-related complications for LBBP, namely postoperative septum perforation, postoperative lead dislodgement, intraoperative septum injury, and intraoperative lead fracture, were low. No adverse clinical outcomes were demonstrated after successful repositioning of the lead and appropriate treatment.

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Left bundle branch area pacing is superior to right ventricular septum pacing concerning depolarization‐repolarization reserve

Cited by 53 publications

References 23 publications

Clinical outcomes of left bundle branch pacing compared to right ventricular apical pacing in patients with atrioventricular block

Clinical outcomes of left bundle branch pacing compared to right ventricular apical pacing in patients with atrioventricular block

Quantification of Acute Myocardial Damage Secondary to Implantation of Electrodes for the Left Bundle Branch Area Pacing

Procedure-Related Complications of Left Bundle Branch Pacing: A Single-Center Experience

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