Cardiology Department. Hospital Universitario Reina Sofía. Cordoba. Spain; Instituto Maimónides de Investigación Biomédica de Cordoba (IMIBIC). Spain.
Cardiology Department. Hospital Universitario Reina Sofía. Cordoba. Spain; Instituto Maimónides de Investigación Biomédica de Cordoba (IMIBIC). Spain.
Curr Probl Cardiol. 2025 Jan;50(1):102886. doi: 10.1016/j.cpcardiol.2024.102886. Epub 2024 Oct 30.
Left bundle branch area pacing (LBBAP) seems to be an alternative to coronary sinus pacing in patients with non-ischaemic dilated cardiomyopathy (NI-DCM) with left bundle branch block (LBBB) and in pacing-induced cardiomyopathy (PICM). The aim of the study was to compare the response of LBBAP in severe forms of both entities.
Prospective study of patients with severe forms of PICM and NI-DCM in NYHA II-IV who underwent LBBAP. Clinical, electrocardiographic, echocardiographic and electrical parameters were analysed and the medium-term prognostic impact was assessed.
Eighty patients were included, 25 with PICM and 55 with NI-DCM. PICM patients were older (PICM 75 [IQR 71-83.5] y.o vs NI-DCM 72 [IQR 60-78.5] y.o;p=0.01) and with longer baseline QRS duration (PICM 180 [IQR 167-194] ms vs NI-DCM 168 [IQR 153-178] ms;p<0.01), with no differences in left ventricular ejection fraction (LVEF) or medical treatment. QRS reduction occurred in both groups, being greater in PICM (PICM CI 95% 54±20 ms, p<0.01; NI-DCM CI 95% 40±15 ms;p<0.01). A NT-ProBNP levels reduction and LVEF improvement were observed without differences between groups. At follow-up, there were no differences in admissions for HF (PICM 4.2% vs NI-DCM 11%;p=0.413), cardiac mortality (PICM 14.9% vs NI-DCM 2.9%;p=0.13) and all-cause mortality (PICM 21.7% vs NI-DCM 10.9%;p=0.08).
LBBAP is an effective technique with a NT-ProBNP levels reduction and LVEF improvement in both groups without differences. At follow-up, both groups had a low rate of HF readmissions and there was a non-significant trend toward higher total mortality in PICM.
左束支区域起搏（LBBAP）似乎是左束支传导阻滞（LBBB）伴非缺血性扩张型心肌病（NI-DCM）和起搏诱导心肌病（PICM）患者替代冠状窦起搏的一种选择。本研究的目的是比较两种严重程度患者的 LBBAP 反应。
对 NYHA II-IV 级严重 PICM 和 NI-DCM 患者进行前瞻性 LBBAP 研究。分析临床、心电图、超声心动图和电参数，并评估中期预后影响。
共纳入 80 例患者，其中 25 例为 PICM，55 例为 NI-DCM。PICM 患者年龄较大（PICM 75 [IQR 71-83.5] 岁 vs NI-DCM 72 [IQR 60-78.5] 岁；p=0.01），基线 QRS 持续时间较长（PICM 180 [IQR 167-194] ms vs NI-DCM 168 [IQR 153-178] ms；p<0.01），但左心室射血分数（LVEF）或药物治疗无差异。两组 QRS 波均有减少，PICM 组减少更明显（PICM CI 95% 54±20 ms，p<0.01；NI-DCM CI 95% 40±15 ms；p<0.01）。两组均观察到 NT-ProBNP 水平降低和 LVEF 改善，但组间无差异。随访时，HF 再入院率无差异（PICM 4.2% vs NI-DCM 11%；p=0.413），心脏死亡率也无差异（PICM 14.9% vs NI-DCM 2.9%；p=0.13），全因死亡率也无差异（PICM 21.7% vs NI-DCM 10.9%；p=0.08）。
LBBAP 是一种有效的技术，可降低 NT-ProBNP 水平并改善两组患者的 LVEF，两组间无差异。随访时，两组 HF 再入院率均较低，PICM 组总死亡率呈升高趋势但无统计学意义。
