Department of Cardiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China.
J Coll Physicians Surg Pak. 2021 Nov;31(11):1268-1272. doi: 10.29271/jcpsp.2021.11.1268.
To investigate the clinical safety and electrocardiogram (ECG) characteristics in patients with left bundle branch area pacing (LBBAP).
Retrospective study.
Department of Cardiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China, from May 2018 to January 2020.
Patients scheduled for Left Bandle Branch Area Pacing (LBBAP), who were admitted due to bradycardia, had been prospectively recruited. The Medtronic 3830 pacing lead was first placed at the right ventricular (RV) side of the interventricular septum (IVS) with pacing parameters (pacing threshold, pacing impedance and sensing amplitude) and ECG characteristics [QRS morphology, paced QRS duration and stimulus to peak left ventricular activation time (Sti-LVAT)] measured, which was called the right ventricular septum pacing group (RVSP). Then the pacing lead was screwed towards the left ventricular (LV) side of the IVS; and the corresponding parameters and ECG characteristics were assessed, which was called LBBAP group.
RVSP caused left bundle block (LBBB) morphology on ECG, while pacing at left bundle area led to right bundle branch block (RBBB) morphology, without remarkable difference in pacing threshold and pacing impedance. The sensing amplitude during LBBAP was significantly higher compared with RVSP (p <0.05). QRS duration and Sti-LVAT were significantly shorter when paced on LBBAP compared with RVSP (p <0.05). Patients with LBBB morphology in intrinsic rhythm showed the greatest reduction in paced QRS duration and Sti-LVAT compared to patients with RBBB morphology or no bundle branch block morphology (p <0.001). There were no complications during pacemaker implantation and no adverse events observed during follow-up. The pacing parameters remained stable during the follow-up (9.2 ± 3.7 months).
Compared with pacing on RVSP, patients with LBBAP showed RBBB morphology with significantly reduced QRS duration and LV Sti-LVAT under similar pacing parameters. LBBAP is safe and feasible and may be a promising strategy for patients with LBBB morphology who are indicated for ventricular pacing. Key Words: Physiological pacing, Left bundle branch pacing, Right ventricular pacing, Left bundle branch block, Pacemaker.
研究左束支区域起搏（LBBAP）患者的临床安全性和心电图（ECG）特征。
回顾性研究。
中国蚌埠医学院第一附属医院心内科，2018 年 5 月至 2020 年 1 月。
因心动过缓而入院的拟行左束支区域起搏（LBBAP）的患者被前瞻性招募。首先将美敦力 3830 起搏导线置于室间隔（IVS）的右心室（RV）侧，测量起搏参数（起搏阈值、起搏阻抗和感知幅度）和心电图特征[QRS 形态、起搏 QRS 持续时间和刺激至左心室激活时间峰值（Sti-LVAT）]，称为右室间隔起搏组（RVSP）。然后将起搏导线向 IVS 的左心室（LV）侧旋入；并评估相应的参数和心电图特征，称为 LBBAP 组。
RVSP 在心电图上引起左束支传导阻滞（LBBB）形态，而在左束支区域起搏时则引起右束支传导阻滞（RBBB）形态，起搏阈值和起搏阻抗无显著差异。LBBAP 时的感知幅度明显高于 RVSP（p<0.05）。与 RVSP 相比，LBBAP 时 QRS 持续时间和 Sti-LVAT 明显缩短（p<0.05）。固有节律呈 LBBB 形态的患者与呈 RBBB 形态或无束支传导阻滞形态的患者相比，起搏 QRS 持续时间和 Sti-LVAT 的缩短幅度最大（p<0.001）。起搏器植入过程中无并发症，随访期间无不良事件发生。随访期间起搏参数稳定（9.2±3.7 个月）。
与 RVSP 起搏相比，LBBAP 患者呈 RBBB 形态，在相似的起搏参数下 QRS 持续时间和 LV Sti-LVAT 明显缩短。LBBAP 安全可行，可能是适合心室起搏的 LBBB 形态患者的一种有前途的策略。关键词：生理性起搏、左束支起搏、右心室起搏、左束支传导阻滞、起搏器。
