Yang Dandan, Ma Qunchao, Zhu Hong, Wang Lihua, Xiang Meixiang, Wang Jian'an, Pan Xiaohong
Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China.
Front Cardiovasc Med. 2025 Jan 14;12:1518349. doi: 10.3389/fcvm.2025.1518349. eCollection 2025.
This retrospective cohort study aimed to investigate the efficacy of dual-chamber left Bundle branch pacing (LBBP) as an alternative therapy for heart failure patients with complete left bundle branch block (CLBBB) and indications for defibrillator with cardiac resynchronization therapy (CRT-D).
34 patients met inclusion criteria were enrolled in the study. These criteria included a left ventricular ejection fraction (LVEF) of lower than 35%, a New York Heart Association functional class of II-IV, CLBBB meeting Strauss's criteria, intraventricular dyssynchrony, and confirmed correction of CLBBB during LBBP. Patients with ischemic cardiomyopathy, left ventricular noncompaction, significant late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR), and indications for an implantable cardioverter-defibrillator (ICD) as secondary prevention were excluded.
Post-LBBP, the LVEF improved from 31.1 ± 4.0% to 61.0 ± 6.0% ( < 0.001). All patients exhibited a super-response to LBBP cardiac resynchronization therapy, achieving complete improvement in cardiac function with a LVEF exceeding 50%. Septal-to-posterior wall motion delay (SPWMD) and systolic dyssynchrony index (SDI) were indicators of intraventricular synchrony, SPWMD decreased from 271.4 ± 76.4 to 42.2 ± 22.9 ( < 0.001), and SDI decreased from 12.5 ± 5.3% to 1.9 ± 1.0% after implantation ( < 0.001).
Heart failure patients meeting the following criteria may be considered for dual-chamber pacing as an alternative to CRT-D, potentially avoiding the need for ICD implantation: (1) CLBBB meeting Strauss's criteria, (2) presence of intraventricular dyssynchrony on echocardiogram, (3) exclusion of secondary prevention ICD indications, (4) absence of evident LGE on CMR, and (5) successful correction of CLBBB during LBBP.
本回顾性队列研究旨在探讨双腔左束支起搏（LBBP）作为患有完全性左束支传导阻滞（CLBBB）且有心脏再同步化治疗除颤器（CRT-D）指征的心力衰竭患者的替代治疗方法的疗效。
34例符合纳入标准的患者被纳入本研究。这些标准包括左心室射血分数（LVEF）低于35%、纽约心脏协会心功能分级为II-IV级、符合施特劳斯标准的CLBBB、室内不同步，以及在LBBP期间证实CLBBB得到纠正。排除患有缺血性心肌病、左心室心肌致密化不全、心脏磁共振成像（CMR）上有显著晚期钆增强（LGE）以及有植入式心律转复除颤器（ICD）作为二级预防指征的患者。
LBBP术后，LVEF从31.1±4.0%提高到61.0±6.0%（<0.001）。所有患者对LBBP心脏再同步化治疗均表现出超反应，心功能完全改善，LVEF超过50%。室间隔至后壁运动延迟（SPWMD）和收缩期不同步指数（SDI）是室内同步性的指标，植入后SPWMD从271.4±76.4减少到42.2±22.9（<0.001），SDI从12.5±5.3%降低到1.9±1.0%（<0.001）。
符合以下标准的心力衰竭患者可考虑双腔起搏作为CRT-D的替代方法，有可能避免ICD植入的需要：（1）符合施特劳斯标准的CLBBB；（2）超声心动图显示存在室内不同步；（3）排除二级预防ICD指征；（4）CMR上无明显LGE；（5）LBBP期间CLBBB成功纠正。
