Zhuo Jinhui, Chen Canghao, Lin Junhua, Wang Jing, Fu Fayuan
Department of Cardiology, Fujian Medical University Union Hospital, Fujian Institute of Coronary Heart Disease, Fujian Heart Medical Center, Fuzhou, 350001, Fujian, China.
Heart Vessels. 2025 Jan 3. doi: 10.1007/s00380-024-02512-4.
Left bundle branch pacing (LBBP) is an emerging physiological pacing technique characterized by stable pacing parameters and a narrower QRS duration. This study aims to compare the long-term efficacy and safety of biventricular pacing (BIVP) and LBBP in patients with heart failure with reduced ejection fraction (HFrEF) and complete left bundle branch block (CLBBB). A retrospective analysis was conducted on 35 patients with chronic HFrEF accompanied by CLBBB treated at our center from April 2018 to October 2022. The patients were divided into two groups based on the surgical technique: the LBBP group and the BIVP group. Postoperative follow-up data were collected, including pacing parameters, QRS duration, echocardiographic indices (left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), mitral and tricuspid regurgitation), NT-proBNP levels, and New York Heart Association (NYHA) classification. n addition, postoperative complications, heart failure readmission rates, and mortality rates were observed. 35 patients were recruited, 18 for LBBP and 17 for BIVP. The LBBP group demonstrated significantly lower pacing thresholds and impedance at 12 months post-surgery compared to the BIVP group (p < 0.05). The QRS duration in the LBBP group was significantly narrower than that in the BIVP group at 6, 12, and 24 months (p < 0.05). At 24 months post-surgery, LVEDD and LVESD were significantly lower in the LBBP group than those in the BIVP group (p < 0.05). No significant differences were observed between groups in response rates, tricuspid and mitral regurgitation, NYHA class, NT-proBNP levels, all-cause mortality, or heart failure rehospitalization rates (p > 0.05). LBBP may be a relatively safe and effective resynchronization therapy, serving as a complementary approach to BIVP for patients with HFrEF and CLBBB.
左束支起搏（LBBP）是一种新兴的生理性起搏技术，其特点是起搏参数稳定且QRS时限更窄。本研究旨在比较双心室起搏（BIVP）和LBBP在射血分数降低的心力衰竭（HFrEF）合并完全性左束支传导阻滞（CLBBB）患者中的长期疗效和安全性。对2018年4月至2022年10月在本中心接受治疗的35例慢性HFrEF合并CLBBB患者进行回顾性分析。根据手术技术将患者分为两组：LBBP组和BIVP组。收集术后随访数据，包括起搏参数、QRS时限、超声心动图指标（左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）、二尖瓣和三尖瓣反流）、NT-proBNP水平以及纽约心脏协会（NYHA）分级。此外，观察术后并发症、心力衰竭再入院率和死亡率。共招募35例患者，18例接受LBBP，17例接受BIVP。与BIVP组相比，LBBP组术后12个月的起搏阈值和阻抗显著更低（p<0.05）。LBBP组在6个月、12个月和24个月时的QRS时限明显窄于BIVP组（p<0.05）。术后24个月，LBBP组的LVEDD和LVESD显著低于BIVP组（p<0.05）。两组在有效率、三尖瓣和二尖瓣反流、NYHA分级、NT-proBNP水平、全因死亡率或心力衰竭再住院率方面未观察到显著差异（p>0.05）。LBBP可能是一种相对安全有效的再同步治疗方法，可作为HFrEF和CLBBB患者BIVP的补充方法。
