Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Information Center of West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Cardiovasc Ther. 2023 Aug 21;2023:6659048. doi: 10.1155/2023/6659048. eCollection 2023.
We aim to conduct a comparison of the safety and effectiveness performance between left bundle branch area pacing (LBBAP) and right ventricular pacing (RVP) regimens for patients with atrioventricular block (AVB).
This observational cohort study included patients who underwent pacemaker implantations with LBBAP or RVP for AVB indications from the 1st of January 2018 to the 18th of November 2021 at West China Hospital. The primary composite outcome included all-cause mortality, lead failure, or heart failure hospitalization (HFH). The secondary outcome included periprocedure complication, cardiac death, or recurrent unexplained syncope. A 1 : 1 propensity score-matched cohort was conducted for left ventricular (LV) function analysis.
A total of 903 patients met the inclusion criteria and completed clinical follow-up. After adjusting for the possible confounders, LBBAP was independently associated with a lower risk of the primary outcome (OR 0.48, 95% CI 0.28 to 0.83, = 0.009), including a lower risk of all-cause mortality and HFH. No significant difference in the secondary outcome was detected between the groups except that LBBAP was independently associated with a lower risk of recurrent unexplained syncope. In the propensity-score matching cohort of echocardiographic analysis, the LV systolic dyssynchrony index was lower in LBBAP compared with that in RVP (5.68 ± 1.92 vs. 6.50 ± 2.28%, = 0.012).
Compared to conventional RVP, LBBAP is a feasible novel pacing model associated with a significant reduction in the primary composite outcome. Moreover, LBBAP significantly reduces the risk of recurrent unexplained syncope and improves LV systolic synchrony. This study is registered with ClinicalTrials.gov NCT05722379.
比较左束支区域起搏（LBBAP）与右心室起搏（RVP）治疗房室传导阻滞（AVB）患者的安全性和有效性。
本观察性队列研究纳入了 2018 年 1 月 1 日至 2021 年 11 月 18 日期间在华西医院因 AVB 指征行起搏器植入的 LBBAP 或 RVP 患者。主要复合结局包括全因死亡率、导线故障或心力衰竭住院（HFH）。次要结局包括围手术期并发症、心源性死亡或复发性不明原因晕厥。进行了 1:1 倾向评分匹配的左心室（LV）功能分析队列。
共有 903 例患者符合纳入标准并完成了临床随访。调整可能的混杂因素后，LBBAP 与较低的主要结局风险独立相关（OR 0.48，95%CI 0.28 至 0.83， = 0.009），包括全因死亡率和 HFH 的风险降低。两组间次要结局无显著差异，除 LBBAP 与复发性不明原因晕厥的风险降低独立相关外。在超声心动图分析的倾向评分匹配队列中，LBBAP 组的 LV 收缩不同步指数低于 RVP 组（5.68 ± 1.92 比 6.50 ± 2.28%， = 0.012）。
与传统的 RVP 相比，LBBAP 是一种可行的新型起搏模式，与主要复合结局显著降低相关。此外，LBBAP 显著降低了复发性不明原因晕厥的风险，并改善了 LV 收缩同步性。本研究在 ClinicalTrials.gov 注册，注册号为 NCT05722379。
