Department of Cardiology, Shanghai Institution of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China.
Europace. 2020 Dec 26;22(Suppl_2):ii36-ii44. doi: 10.1093/europace/euaa294.
The aim of this study is to prospectively assess the feasibility and safety of left bundle branch pacing (LBBP) when compared with right ventricular pacing (RVP) during mid-long-term follow-up in a large cohort.
Patients (n = 554) indicated for pacemaker implantation were prospectively and consecutively enrolled and were non-randomized divided into LBBP group and RVP group. The levels of cTnT and N-terminal pro-B type natriuretic peptide were measured and compared within 2 days post-procedure between two groups. Implant characteristics, procedure-related complications, and clinical outcomes were also compared. Pacing thresholds, sensing, and impedance were assessed during procedure and follow-up. Left bundle branch pacing was feasible with a success rate of 94.8% with high incidence of LBB potential (89.9%), selective LBBP (57.8%), and left deviation of paced QRS axis (79.7%) with mean Sti-LVAT of 65.07 ± 8.58 ms. Paced QRS duration was significantly narrower in LBBP when compared with RVP (132.02 ± 7.93 vs. 177.68 ± 15.58 ms, P < 0.0001) and the pacing parameters remained stable in two groups during 18 months follow-up. cTnT elevation was more significant in LBBP when compared with RVP within 2 days post-procedure (baseline: 0.03 ± 0.03 vs. 0.02 ± 0.03 ng/mL, P = 0.002; 1 day post-procedure: 0.13 ± 0.09 vs. 0.04 ± 0.03 ng/mL, P < 0.001; 2 days post-procedure: 0.10 ± 0.08 vs. 0.03 ± 0.08 ng/mL, P < 0.001). The complications and cardiac outcomes were not significantly different between two groups.
Left bundle branch pacing was feasible in bradycardia patients associated with stable pacing parameters during 18 months follow-up. Paced QRS duration was significantly narrower than that of RVP. Though cTnT elevation was more significant in LBBP within 2 days post-procedure, the complications, and cardiac outcomes were not significantly different between two groups.
本研究旨在前瞻性评估左束支起搏（LBBP）与右心室起搏（RVP）在中-长期随访期间的可行性和安全性。
前瞻性连续招募了 554 名需要植入起搏器的患者，并将其非随机分为 LBBP 组和 RVP 组。比较两组术后 2 天内 cTnT 和 N 端脑钠肽前体（NT-proBNP）水平。比较植入特征、与手术相关的并发症和临床结果。术中及随访时评估起搏阈值、感知和阻抗。左束支起搏成功率为 94.8%，左束支电位（LBBP）发生率高（89.9%）、选择性 LBBP（57.8%）和起搏 QRS 轴左偏（79.7%），平均 Sti-LVAT 为 65.07±8.58ms。与 RVP 相比，LBBP 时起搏 QRS 时限明显变窄（132.02±7.93 比 177.68±15.58ms，P<0.0001），两组在 18 个月随访期间起搏参数稳定。与 RVP 相比，LBBP 术后 2 天内 cTnT 升高更显著（基线：0.03±0.03 比 0.02±0.03ng/ml，P=0.002；1 天：0.13±0.09 比 0.04±0.03ng/ml，P<0.001；2 天：0.10±0.08 比 0.03±0.08ng/ml，P<0.001）。两组并发症和心脏结局无显著差异。
在 18 个月的随访期间，左束支起搏在心动过缓患者中是可行的，起搏参数稳定。起搏 QRS 时限明显窄于 RVP。虽然 LBBP 术后 2 天内 cTnT 升高更显著，但两组并发症和心脏结局无显著差异。
