Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China.
Medicine (Baltimore). 2022 Mar 18;101(11). doi: 10.1097/MD.0000000000029071.
Left bundle branch area pacing (LBBaP) has recently emerged as a new physiological pacing strategy. The purpose of this study is to compare LBBaP with right ventricular sepal pacing (RVSP) in terms of their clinical safety and efficacy.From February 2019 to May 2020, consecutive pacing-indicated patients were prospectively enrolled and divided into 2 groups. Ventricular synchrony indexes such as QRS duration (QRSd), interventricular mechanical delay and septal-posterior wall motion delay, left ventricular function such as left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF), pacing parameters, and complications were evaluated in the perioperative period and during follow-up.LBBaP was successful in 45 patients (88.2%), and finally 46 patients underwent RVSP. With LBBaP, ventricular electricalmechanical synchrony were similar to those of native-conduction system (P = .78). However, the ventricular electrical synchrony (QRSd, 108.47±7.64 vs 130.63±13.63ms, P < .001) and mechanical synchrony (interventricular mechanical delay, 27.68±4.33 vs 39.88±5.83, P < .001; septal-posterior wall motion delay, 40.39±23.21 vs 96.36±11.55, P < .001) in the LBBaP group were significantly better than those in the RVSP group. No significant differences in LVEDD (46 [44-48.5] vs 47 [44-52] mm, P = .49) and LVEF% (66 [62.5-70] vs 64 [61-68], P = .76) was observed between 2 groups at last follow-up. But, in the subgroup analysis, LVEDD was shorter (46 [44-49] vs 50 [47-58] mm, P = .03) and the LVEF% was higher (65 [62-68] vs 63 [58-65], P = .02) in the LBBaP-H (high ventricular pacing ratio >40%) group compared with RVSP-H group at last follow-up. There were lower capture thresholds (0.59±0.18V vs 0.71 ± 0.26 V, P = 0.01) at implantation in the LBBaP group than those in the RVSP group, with R-wave amplitudes and pacing impedances showing no significant difference between 2 groups. No serious complications were found in both 2 groups at implantation and follow-ups.This study confirms the clinical safety and efficacy of LBBaP, and it produces better ventricular electrical-mechanical synchrony than RVSP. The event of pacing-induced left ventricular dysfunction is lower in the LBBaP-H group than RVSP-H group.
左束支区域起搏（LBBaP）最近已成为一种新的生理性起搏策略。本研究旨在比较 LBBaP 与右室间隔部起搏（RVSP）在临床安全性和疗效方面的差异。
从 2019 年 2 月至 2020 年 5 月，连续入选起搏指征患者，并前瞻性地分为 2 组。在围手术期和随访期间评估心室同步指标，如 QRS 时限（QRSd）、室间机械延迟和室间隔-后壁运动延迟，左心室功能，如左心室舒张末期直径（LVEDD）和左心室射血分数（LVEF），起搏参数和并发症。
LBBaP 成功 45 例（88.2%），最终 46 例患者行 RVSP。与 RVSP 相比，LBBaP 的心室电机械同步性相似（P =.78）。然而，心室电同步性（QRSd，108.47±7.64 比 130.63±13.63ms，P <.001）和机械同步性（室间机械延迟，27.68±4.33 比 39.88±5.83，P <.001；室间隔-后壁运动延迟，40.39±23.21 比 96.36±11.55，P <.001）在 LBBaP 组明显优于 RVSP 组。2 组最后随访时 LVEDD（46[44-48.5]比 47[44-52]mm，P =.49）和 LVEF%（66[62.5-70]比 64[61-68]，P =.76）差异无统计学意义。但在亚组分析中，与 RVSP-H 组相比，LBBaP-H 组（高心室起搏比例>40%）最后随访时 LVEDD 更短（46[44-49]比 50[47-58]mm，P =.03），LVEF%更高（65[62-68]比 63[58-65]，P =.02）。LBBaP 组植入时的捕获阈值（0.59±0.18V 比 0.71 ± 0.26V，P = 0.01）低于 RVSP 组，R 波振幅和起搏阻抗在 2 组之间无显著差异。2 组在植入和随访期间均未发现严重并发症。
本研究证实了 LBBaP 的临床安全性和疗效，与 RVSP 相比，它产生了更好的心室电机械同步性。与 RVSP-H 组相比，LBBaP-H 组起搏诱导的左心室功能障碍发生率较低。
