Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, 300 Guangzhou Road, Nanjing, China.
School of Computing, University of Southern Mississippi, Long Beach, MS, USA.
Europace. 2019 Nov 1;21(11):1694-1702. doi: 10.1093/europace/euz188.
Left bundle branch pacing (LBBP) recently emerges as a novel pacing modality. We aimed to evaluate the feasibility and cardiac synchrony of permanent LBBP in bradycardia patients.
Left bundle branch pacing was successfully performed in 56 pacemaker-indicated patients with normal cardiac function. Left bundle branch pacing was achieved by penetrating the interventricular septum (IVS) into the left side sub-endocardium with the pacing lead. His-bundle pacing (HBP) was successfully performed in another 29 patients, 19 of whom had right ventricular septal pacing (RVSP) for backup pacing. The QRS duration, left ventricular (LV) activation time (LVAT), and mechanical synchrony using phase analysis of gated SPECT myocardial perfusion imaging were evaluated. Paced QRS duration in LBBP group was significantly shorter than that in RVSP group (117.8 ± 11.0 ms vs. 158.1 ± 11.1 ms, P < 0.0001) and wider than that in HBP group (99.7 ± 15.6 ms, P < 0.0001). Left bundle branch potential was recorded during procedure in 37 patients (67.3%). Left bundle branch pacing patients with potential had shorter LVAT than those without potential (73.1 ± 11.3 ms vs. 83.2 ± 16.8 ms, P = 0.03). Left bundle branch pacing patients with potential had similar LV mechanical synchrony to those in HBP group. R-wave amplitude and capture threshold of LBBP were 17.0 ± 6.7 mV and 0.5 ± 0.1 V, respectively at implant and remained stable during a mean follow-up of 4.5 months without lead-related complications.
Permanent LBBP through IVS is safe and feasible in bradycardia patients. Left bundle branch pacing could achieve favourable cardiac electrical and LV mechanical synchrony.
左束支起搏（LBBP）最近成为一种新的起搏方式。我们旨在评估在心动过缓患者中进行永久性 LBBP 的可行性和心脏同步性。
在 56 名具有正常心功能的起搏器指征患者中成功进行了左束支起搏。通过将起搏导线穿透室间隔（IVS）进入左心内膜下侧来实现左束支起搏。在另外 29 名患者中成功进行了希氏束起搏（HBP），其中 19 名患者进行了右室间隔起搏（RVSP）作为备用起搏。评估了 QRS 持续时间、左心室（LV）激活时间（LVAT）和门控 SPECT 心肌灌注成像相位分析的机械同步性。LBBP 组的起搏 QRS 持续时间明显短于 RVSP 组（117.8±11.0ms 比 158.1±11.1ms，P<0.0001），宽于 HBP 组（99.7±15.6ms，P<0.0001）。在 37 名患者（67.3%）的手术过程中记录到左束支电位。有左束支电位的左束支起搏患者的 LVAT 短于无左束支电位的患者（73.1±11.3ms 比 83.2±16.8ms，P=0.03）。有左束支电位的左束支起搏患者与 HBP 组的 LV 机械同步性相似。LBBP 的 R 波振幅和捕获阈值分别为植入时的 17.0±6.7mV 和 0.5±0.1V，在平均 4.5 个月的随访期间保持稳定，无导线相关并发症。
通过 IVS 在心动过缓患者中进行永久性 LBBP 是安全可行的。左束支起搏可实现良好的心脏电和 LV 机械同步性。
