Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Heart Rhythm. 2019 Dec;16(12):1766-1773. doi: 10.1016/j.hrthm.2019.04.043. Epub 2019 Apr 29.
Left bundle branch area pacing (LBBAP), a new pacing approach, lacks adequate evaluation.
To assess the feasibility, safety, and acute effect of permanent LBBAP in patients with atrioventricular block (AVB).
A total of 33 AVB patients with indications for ventricular pacing were recruited. Electrocardiograms, pacing parameters, echocardiographic measurements, and complications associated with LBBAP were evaluated perioperatively and at 3-month follow-up. Successful LBBAP was defined as a paced QRS morphology of right bundle branch block pattern in lead V and QRS duration (QRSd) less than 130 ms.
LBBAP was successfully performed in 90.9% (30/33) of patients (mean age: 55.1 ± 18.5 years; 66.7% male). The mean capture threshold was similar during the procedure (0.76 ± 0.26 V at 0.4 ms) and at the 3-month follow-up (0.64 ± 0.20 V at 0.4 ms). The paced QRSd was 112.8 ± 10.9 ms during the procedure and 116.8 ± 10.4 ms at the 3-month follow-up. Baseline left or right bundle branch block was corrected (intrinsic QRSd 153.3 ± 27.8 ms vs paced QRSd 122.2 ± 9.9 ms) with a success rate of 68.7% (11/16). One ventricular septal lead perforation occurred soon after the procedure with characteristics of pacing failure, and lead revision was successful. Cardiac function and left ventricular synchronization by 2-dimensional echocardiographic strain imaging at the 3-month follow-up slightly improved compared with that at baseline.
Permanent LBBAP yielded a stable threshold, a narrow QRSd, and preserved left ventricular synchrony with few complications. Our preliminary results indicate that LBBAP holds promise as an attractive physiological pacing strategy for AVB.
左束支区域起搏（LBBAP）是一种新的起搏方法，其评估不足。
评估房室传导阻滞（AVB）患者行永久性 LBBAP 的可行性、安全性和急性效果。
共纳入 33 例有行心室起搏指征的 AVB 患者。评估围手术期和 3 个月随访时的心电图、起搏参数、超声心动图测量值以及与 LBBAP 相关的并发症。成功的 LBBAP 定义为 V 导联呈右束支传导阻滞图形且 QRS 时限（QRSd）＜130 ms 的起搏 QRS 形态。
90.9%（30/33）的患者（平均年龄：55.1±18.5 岁；66.7%为男性）成功进行了 LBBAP。在手术过程中和 3 个月随访时，平均捕获阈值相似（0.4 ms 时分别为 0.76±0.26 V 和 0.64±0.20 V）。手术过程中的起搏 QRSd 为 112.8±10.9 ms，3 个月随访时为 116.8±10.4 ms。术前存在左束支或右束支传导阻滞（固有 QRSd 为 153.3±27.8 ms 与起搏 QRSd 为 122.2±9.9 ms），成功率为 68.7%（11/16）。术后不久发生 1 例心室间隔导联穿孔，表现为起搏失败，经导线修正成功。与基线相比，3 个月随访时的心脏功能和二维超声应变成像评估的左心室同步性略有改善。
永久性 LBBAP 起搏阈值稳定、QRSd 窄、保留左心室同步性，且并发症少。我们的初步结果表明，LBBAP 作为一种有吸引力的生理性起搏策略，有望应用于 AVB。
