Wu Sijin, Lu Wenzhao, Chen Zhongli, Hu Qingyun, Li Yao, Gao Yuan, Wang Wei, Wu Ying, Chen Ruohan, Dai Yan, Chen Keping, Zhang Shu
State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 100037 Beijing, China.
Rev Cardiovasc Med. 2023 Dec 27;24(12):372. doi: 10.31083/j.rcm2412372. eCollection 2023 Dec.
Several previous studies have explored the potential arterial blood pressure (BP) changes in patients undergoing right ventricular pacing (RVP), however, the relationship between left bundle branch area pacing (LBBAP) and BP variations remains unknown. This study aimed to examine the acute BP variations following LBBAP and RVP implantation in patients with bradycardia.
We conducted a single-center retrospective study including all patients who underwent de-novo dual-chamber pacemaker implantation between January 2019 and June 2021. Patients were divided into two groups, LBBAP and RVP, and propensity score-matching (PSM) was used to balance confounding factors. Three time periods were defined according to the timing of the implant: baseline (within 24 hours before implantation), hyper-acute period (0-24 hours post-implantation), and acute period (24-48 hours post-implantation). BP was measured at least three times per period using an arm pressure cuff and then averaged for analysis, which allowed us to determine the acute impact of pacemaker implantation on BP.
From a cohort of 898 patients, 193 LBBAP receivers were matched to 193 RVP receivers. A significant decrease in systolic BP (SBP) after the implantation was observed in the study cohort, from baseline 137.3 9.2 mmHg to the acute period of 127.7 9.4 mmHg ( 0.001). The LBBAP group exhibited a greater SBP reduction than the RVP group ( 11.6 6.2 mmHg vs. 7.6 5.8 mmHg, 0.001). In further subgroup analysis, LBBAP receivers who had high baseline SBP ( 0.001) and those without using anti-hypertensive drugs ( = 0.045) appeared to have a higher magnitude of SBP reduction.
Permanent pacemaker implantation may contribute to an acute decrease in systolic BP, which was more pronounced in LBBAP receivers. Future experimental and clinical investigations are necessary to explore the underlying mechanisms and the long-term hemodynamic effects of LBBAP versus RVP.
此前已有多项研究探讨了接受右心室起搏（RVP）患者的潜在动脉血压（BP）变化，然而，左束支区域起搏（LBBAP）与血压变化之间的关系仍不清楚。本研究旨在检查心动过缓患者植入LBBAP和RVP后的急性血压变化。
我们进行了一项单中心回顾性研究，纳入了2019年1月至2021年6月期间所有接受初次双腔起搏器植入的患者。患者分为两组，LBBAP组和RVP组，并采用倾向评分匹配（PSM）来平衡混杂因素。根据植入时间定义了三个时间段：基线期（植入前24小时内）、超急性期（植入后0 - 24小时）和急性期（植入后24 - 48小时）。每个时间段使用手臂袖带至少测量三次血压，然后取平均值进行分析，这使我们能够确定起搏器植入对血压的急性影响。
在898例患者队列中，193例接受LBBAP的患者与193例接受RVP的患者进行了匹配。研究队列中观察到植入后收缩压（SBP）显著下降，从基线时的137.3±9.2 mmHg降至急性期的127.7±9.4 mmHg（P<0.001）。LBBAP组的SBP下降幅度大于RVP组（-11.6±6.2 mmHg对-7.6±5.8 mmHg，P<0.001）。在进一步的亚组分析中，基线SBP较高的LBBAP接受者（P<0.001）和未使用抗高血压药物的接受者（P = 0.045）的SBP下降幅度似乎更大。
永久性起搏器植入可能导致收缩压急性下降，这在LBBAP接受者中更为明显。未来有必要进行实验和临床研究，以探索其潜在机制以及LBBAP与RVP的长期血流动力学效应。
