左束支起搏与双心室起搏对心力衰竭合并左束支传导阻滞患者的长期疗效
Long-term efficacy of left bundle branch pacing and biventricular pacing in patients with heart failure complicated with left bundle branch block.
作者信息
Li Jia, Yi Hongwei, Han Jun, Han Hongwei, Su Xi
机构信息
Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan, Hubei, China.
出版信息
Front Cardiovasc Med. 2024 Feb 29;11:1363020. doi: 10.3389/fcvm.2024.1363020. eCollection 2024.
BACKGROUND
Left bundle branch pacing (LBBP) can physiologically correct complete left bundle branch block (CLBBB), and has become the best alternative to biventricular pacing (BiVP).
OBJECTIVE
To compare the efficacy of LBBP and BiVP in patients with heart failure (HF) complicated with CLBBB.
METHODS
This was a single-center retrospective study. Patients with HF complicated with CLBBB who underwent successful cardiac resynchronization therapy (CRT) in Wuhan Asian Heart Hospital from June 2018 to June 2023 were enrolled and divided into LBBP group and BiVP group according to the pacing method. The primary endpoints were the absolute increase of left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and echocardiographic response rate. Secondary endpoints were all-cause mortality, heart failure hospitalization (HFH), NT-proBNP, paced QRS duration, pacing threshold, and procedural duration.
RESULTS
A total of 120 patients were enrolled in this study, including 60 patients in LBBP group and 60 patients in BiVP group. The median follow-up time was 37 ± 19 months. Compared with BiVP group, LBBP group had a more significant increase in absolute LVEF (ΔLVEF) (14.8 ± 9.9% vs. 10.7 ± 9.0%, = 0.02), a more significant reduction in LVEDD (56.9 ± 10.9 mm vs. 61.1 ± 10.8 mm, = 0.03), and a higher echocardiographic super response rate (65% vs. 45%, = 0.02). There were no significant differences in all-cause mortality (1.7% vs. 10.0%, = 0.11) and HFH (6.7% vs. 13.3%, = 0.22). In terms of paced QRS duration (128.7 ± 14.1 ms vs. 137.5 ± 16.5 ms, = 0.002), pacing threshold (0.72 ± 0.21 V/0.4 ms vs. 1.39 ± 0.51 V/0.4 ms, < 0.001), procedural duration (134.1 ± 32.2 min vs. 147.7 ± 39.4 min, = 0.04), the LBBP group was superior to the BiVP group.
CONCLUSION
In nonischemic cardiomyopathy (NICM) patients with HF combined with CLBBB and LVEF ≤ 35%, LBBP is better than BiVP.
背景
左束支起搏（LBBP）可在生理上纠正完全性左束支传导阻滞（CLBBB），并已成为双心室起搏（BiVP）的最佳替代方案。
目的
比较LBBP与BiVP在心力衰竭（HF）合并CLBBB患者中的疗效。
方法
这是一项单中心回顾性研究。纳入2018年6月至2023年6月在武汉亚洲心脏病医院接受成功心脏再同步治疗（CRT）的HF合并CLBBB患者，并根据起搏方式分为LBBP组和BiVP组。主要终点为左心室射血分数（LVEF）的绝对增加值、左心室舒张末期内径（LVEDD）和超声心动图反应率。次要终点为全因死亡率、心力衰竭住院（HFH）、N末端脑钠肽前体（NT-proBNP）、起搏QRS时限、起搏阈值和手术时间。
结果
本研究共纳入120例患者，其中LBBP组60例，BiVP组60例。中位随访时间为37±19个月。与BiVP组相比，LBBP组的绝对LVEF（ΔLVEF）升高更显著（14.8±9.9% vs. 10.7±9.0%，P = 0.02），LVEDD降低更显著（56.9±10.9 mm vs. 61.1±10.8 mm，P = 0.03），超声心动图超反应率更高（65% vs. 45%，P = 0.02）。全因死亡率（1.7% vs. 10.0%，P = 0.11）和HFH（6.7% vs. 13.3%，P = 0.22）无显著差异。在起搏QRS时限（128.7±14.1 ms vs. 137.5±16.5 ms，P = 0.002）、起搏阈值（0.72±0.21 V/0.4 ms vs. 1.39±0.51 V/0.4 ms，P < 0.001）、手术时间（134.1±32.2 min vs. 147.7±39.4 min，P = 0.04）方面，LBBP组优于BiVP组。
结论
在HF合并CLBBB且LVEF≤35%的非缺血性心肌病（NICM）患者中，LBBP优于BiVP。
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