Ramos-Maqueda Javier, Cabrera-Ramos Mercedes, Melero-Polo Jorge, Montilla-Padilla Isabel, Riaño-Ondiviela Adrián, Ruiz-Arroyo José Ramón
Arrhythmia Unit, Department of Cardiology, University Hospital Clinico Lozano Blesa, Zaragoza, Spain.
Health Investigation Institute Aragon, Zaragoza, Spain.
J Innov Card Rhythm Manag. 2024 Dec 15;15(12):6113-6121. doi: 10.19102/icrm.2024.15123. eCollection 2024 Dec.
Our study evaluated the efficacy and feasibility of left bundle branch area pacing (LBBAP) compared to right ventricular outflow tract septal pacing (RVOSP). We conducted a prospective, single-center, observational study involving 200 consecutive patients who required pacemaker implantation. The patients were divided into two groups (LBBAP and RVOSP), with 100 patients in each group. We aimed to compare the safety and efficacy, as well as the procedure and fluoroscopy times, between the two groups. Additionally, we aimed to describe the learning curve for the LBBAP group. The success and acute complication rates were similar ( = .56 vs. = .65). The procedure time was longer in the LBBAP group compared to the RVOSP group (18 [13-28] vs. 11 [7-17] min; < .001), while the fluoroscopy time was shorter in the LBBAP group compared to the RVOSP group (2.8 [1.3-3.7] vs. 3.1 [2-5.9] min; = .02). The paced QRS interval was narrower in the LBBAP group (123.77 ± 10.25 vs. 159.79 ± 17.0 ms; = .001). There were no significant differences in pacing parameters like R-wave sensing (9.6 ± 5.2 vs. 9.1 ± 4.7 mV; = .91), bipolar impedance (685.9 ± 151.8 vs. 686.5 ± 158.6 Ω; = .98), or pacing threshold (0.70 ± 0.29 vs. 0.64 ± 0.26 V @ 0.4 ms; = .63). In the LBBAP group, both the procedure time (12 [10.5-15] vs. 32 [28.5-38.5] min; < .001) and the fluoroscopy time (2 [1-4.6] vs. 5.1 [3.4-12] min; < .01) were shorter in the last quartile (Q4) compared to the first quartile (Q1). The procedure time was similar between LBBAP Q4 and RVOSP (12 [10.5-15] vs. 11 [7-17] min; = .33). LBBAP is as safe as RVOSP and achieves a narrower paced QRS compared to RVOSP. After a rapid learning curve, a shorter fluoroscopy time and a similar procedure time can be achieved.
我们的研究评估了与右心室流出道间隔起搏（RVOSP）相比，左束支区域起搏（LBBAP）的疗效和可行性。我们进行了一项前瞻性、单中心、观察性研究，纳入了200例连续需要植入起搏器的患者。患者被分为两组（LBBAP组和RVOSP组），每组100例。我们旨在比较两组之间的安全性和疗效，以及手术时间和透视时间。此外，我们旨在描述LBBAP组的学习曲线。成功率和急性并发症发生率相似（分别为0.56和0.65）。与RVOSP组相比，LBBAP组的手术时间更长（18[13 - 28]分钟 vs. 11[7 - 17]分钟；P < 0.001），而LBBAP组的透视时间比RVOSP组短（2.8[1.3 - 3.7]分钟 vs. 3.1[2 - 5.9]分钟；P = 0.02）。LBBAP组的起搏QRS间期更窄（123.77 ± 10.25毫秒 vs. 159.79 ± 17.0毫秒；P = 0.001）。在起搏参数方面，如R波感知（9.6 ± 5.2毫伏 vs. 9.1 ± 4.7毫伏；P = 0.91）、双极阻抗（685.9 ± 151.8欧姆 vs. 686.5 ± 158.6欧姆；P = 0.98）或起搏阈值（0.70 ± 0.29伏 @ 0.4毫秒 vs. 0.64 ± 0.26伏 @ 0.4毫秒；P = 0.63），两组之间没有显著差异。在LBBAP组中，与第一四分位数（Q1）相比，最后四分位数（Q4）的手术时间（12[10.5 - 15]分钟 vs. 32[28.5 - 38.5]分钟；P < 0.001）和透视时间（2[1 - 4.6]分钟 vs. 5.1[3.4 - 12]分钟；P < 0.01）都更短。LBBAP组Q4的手术时间与RVOSP组相似（12[10.5 - 15]分钟 vs. 11[7 - 17]分钟；P = 0.33）。LBBAP与RVOSP一样安全，并且与RVOSP相比，能实现更窄的起搏QRS。经过快速学习曲线后，可以实现更短的透视时间和相似的手术时间。
