Kato Hiroyuki, Sato Toshiaki, Shimeno Kenji, Mito Shinji, Nishida Taku, Soejima Kyoko
Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital Nagoya Japan.
Division of Advanced Arrhythmia Management Kyorin University School of Medicine Mitaka Japan.
J Arrhythm. 2023 Aug 3;39(5):766-775. doi: 10.1002/joa3.12906. eCollection 2023 Oct.
Left bundle branch area pacing (LBBAP) is a novel conduction system pacing technique. In this multicenter study, we aimed to evaluate the procedural success, safety, and preoperative predictors of procedural failure of LBBAP.
LBBAP was attempted in 285 patients with pacemaker indications for bradyarrhythmia, which were mainly atrioventricular block (AVB) (68.1%) and sick sinus syndrome (26.7%). Procedural success and electrophysiological and echocardiographic parameters were evaluated.
LBBAP was successful in 247 (86.7%) patients. Left bundle branch (LBB) capture was confirmed in 54.7% of the population. The primary reasons for procedural failure were the inability of the pacemaker lead to penetrate deep into the septum (76.3%) and failure to achieve shortening of stimulus to left ventricular (LV) activation time in lead V6 (18.4%). Thickened interventricular septum (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.15-5.35), severe tricuspid regurgitation (OR, 8.84; 95% CI, 1.22-64.06), and intraventricular conduction delay (OR, 8.16; 95% CI, 2.32-28.75) were preoperative predictors of procedural failure. The capture threshold and ventricular amplitude remained stable, and no major complications occurred throughout the 2-year follow-up. In patients with ventricular pacing burden >40%, the LV ejection fraction remained high regardless of LBB capture.
Successful LBBAP was affected by abnormal cardiac anatomy and intraventricular conduction. LBBAP is feasible and safe as a primary strategy for patients with AVB, depending on ventricular pacing.
左束支区域起搏（LBBAP）是一种新型的传导系统起搏技术。在这项多中心研究中，我们旨在评估LBBAP的手术成功率、安全性以及手术失败的术前预测因素。
对285例有缓慢性心律失常起搏器植入指征的患者尝试进行LBBAP，这些患者主要为房室传导阻滞（AVB）（68.1%）和病态窦房结综合征（26.7%）。评估手术成功率以及电生理和超声心动图参数。
247例（86.7%）患者LBBAP成功。54.7%的人群证实左束支（LBB）夺获。手术失败的主要原因是起搏器导线无法深入穿透间隔（76.3%）以及未能实现V6导联刺激至左心室（LV）激动时间缩短（18.4%）。室间隔增厚（比值比[OR]，2.48；95%置信区间[CI]，1.15 - 5.35）、严重三尖瓣反流（OR，8.84；95% CI，1.22 - 64.06）和室内传导延迟（OR，8.16；95% CI，2.32 - 28.75）是手术失败的术前预测因素。在整个2年随访期间，夺获阈值和心室振幅保持稳定，未发生重大并发症。在心室起搏比例>40%的患者中，无论LBB是否夺获，LV射血分数均保持较高水平。
LBBAP成功受心脏解剖结构异常和室内传导的影响。对于AVB患者，根据心室起搏情况，LBBAP作为主要策略是可行且安全的。
