Leventopoulos Georgios, Patrinos Panagiotis, Papageorgiou Angeliki, Katechis Spyridon, Perperis Angelos, Travlos Christoforos, Spyropoulou Panagiota, Koutsogiannis Nikolaos, Moulias Athanasios, Davlouros Periklis
Department of Cardiology, University Hospital of Patras, Greece.
Department of Rheumatology, General Hospital Asklepieio Voulas, Athens, Greece.
Hellenic J Cardiol. 2025 Jul-Aug;84:32-42. doi: 10.1016/j.hjc.2024.03.005. Epub 2024 Mar 5.
Left bundle branch area pacing (LBBAP) is an emerging pacing method that may prevent the deleterious effects of right ventricular pacing. The aim of this study is to compare the effects of LBBAP with right ventricular septal pacing (RVSP) in patients with advanced atrioventricular conduction abnormalities and preserved left ventricular ejection fraction.
The effect of pacing was evaluated by echocardiographic indices of dyssynchrony, including global myocardial work efficiency (GWE) and peak systolic dispersion (PSD). The primary endpoint was GWE postprocedural, at 3, 6, and 12 months after the procedure.
Twenty patients received LBBAP and 18 RVSP. Complete follow-up was accomplished in 37 patients (97.4%) due to the death of a patient (RVSP arm) from nonrelated cause. GWE was significantly increased in the group of LBBAP compared to RVSP at all time points (90.8% in LBBAP versus 85.8% in RVSP group at 12 months, p = 0.01). PSD was numerically lower in the LBBAP arm at all time points, yet not statistically significant (56.4 msec in LBBP versus 65.1 msec in RVSP arm at 12 months, p = 0.178). The implantation time was increased (median 93 min in LBBAP versus 45 min in RVSP group, p < 0.01), along with fluoroscopy time and dose area product (DAP), in the arm of LBBAP. There were no severe perioperative acute complications in either group.
LBBAP is an emerging and safe technique for patients with a pacing indication. Despite the longer procedural and fluoroscopy time, as well as higher DAP, LBBAP seems to offer better left ventricular synchrony compared to RVSP, according to GWE measurements.
左束支区域起搏（LBBAP）是一种新兴的起搏方法，可能预防右心室起搏的有害影响。本研究的目的是比较LBBAP与右心室间隔起搏（RVSP）在患有严重房室传导异常且左心室射血分数保留的患者中的效果。
通过超声心动图的不同步指标评估起搏效果，包括整体心肌工作效率（GWE）和收缩期峰值离散度（PSD）。主要终点是术后、术后3个月、6个月和12个月时的GWE。
20例患者接受LBBAP，18例接受RVSP。由于一名患者（RVSP组）因非相关原因死亡，37例患者（97.4%）完成了完整随访。在所有时间点，LBBAP组的GWE均显著高于RVSP组（12个月时，LBBAP组为90.8%，RVSP组为85.8%，p = 0.01）。在所有时间点，LBBAP组的PSD数值均较低，但无统计学意义（12个月时，LBBP组为56.4毫秒，RVSP组为65.1毫秒，p = 0.178）。LBBAP组的植入时间延长（中位数：LBBAP组为93分钟，RVSP组为45分钟，p < 0.01），同时透视时间和剂量面积乘积（DAP）也增加。两组均无严重的围手术期急性并发症。
对于有起搏指征的患者，LBBAP是一种新兴且安全的技术。尽管手术和透视时间较长，以及DAP较高，但根据GWE测量，与RVSP相比，LBBAP似乎能提供更好的左心室同步性。
