Long-term follow-up results of patients with left bundle branch pacing and exploration for potential factors affecting cardiac function

Abstract

Background: Left bundle branch pacing (LBBP) is an alternative strategy for His bundle pacing (HBP). This study aimed to analyze the long-term performance of LBBP and the potential factors affecting long-term cardiac function.Methods: Patients with LBBP were continuously enrolled from January 2018 to August 2020. Pacing parameters, electrocardiogram (ECG), and echocardiography were collected. The anatomic position of LBBP leads was described by echocardiographic and fluoroscopic parameters.Results: A total of 91 patients with a median follow-up of 18 months were enrolled. Most patients maintained stable pacing parameters during follow-up. The intra-septal position of the 3830 lead also remained stable as the distance from the lead tip to the left surface of the ventricular septum was 0.4 (0, 1.4) mm. The overall level of left ventricular ejection fraction (LVEF) slightly increased. 59 patients had improved LVEF (ΔLVEF > 0), while 28 patients had unchanged or reduced LVEF (ΔLVEF ≤ 0). The declines of baseline LVEF, Δ Paced QRSd, and corrected longitudinal distance (longit-dist) of lead-implanted site correlated with LVEF improvement, and these three factors had negative linear correlations with ΔLVEF. Patients with tricuspid valve regurgitation (TVR) deterioration had longer follow-up duration (20.5 vs. 15.0 months, p = 0.01) and shorter Lead-TVA-dist (18.6 vs. 21.6 mm, p = 0.04) than those without TVR deterioration. Conclusion:Patients with LBBP generally remained stable in pacing performance, anatomic lead positions, and cardiac function in long-term follow-up. Baseline LVEF, Δ Paced QRSd, and corrected longit-dist might be associated with potential LVEF decrease, which required further confirmation.

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

“…Recently, Hu et al. published similar results 19 . In 91 patients with LBBAP, baseline LVEF had a negative correlation with ΔLVEF.…”

“…Recently, Hu et al published similar results. 19 In 91 patients with LBBAP, baseline LVEF had a negative correlation with ΔLVEF. In other words, the better baseline LVEF, the smaller LVEF improvement was.…”

“…To date, there is a scarcity of data regarding the impact of LBBAP in such subpopulation of pacemaker candidates. Hu et al 19 presented that in 91 subjects with LBBAP and baseline LVEF ≥40%, during the mean 18-month follow-up, LVEF decreased more than 5% only in 10 subjects (11.5%). Unfortunately, the authors did not assess if there was any case of PICM according to the standard definition.…”