Chopra Maya, Hsieh Ji-Cheng, Mueller William, Braunstein Eric D, Beldner Stuart, Mitra Raman L, Epstein Laurence M, Willner Jonathan, Gabriels James K
Cardiovascular Institute, North Shore University Hospital, Northwell, 2000 Marcus Avenue, New Hyde Park, NY, 11042-1069, USA.
Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA.
J Interv Card Electrophysiol. 2025 Apr 21. doi: 10.1007/s10840-025-02048-1.
Patients with chronic right ventricular (RV) pacing are at risk for developing pacing-induced cardiomyopathy (PICM). Data regarding the incidence of PICM when pacing the RV septum using a leadless pacemaker (LP) are limited. Left bundle branch area pacing (LBBAP) has emerged as a viable alternative to RV pacing with a low incidence of PICM.
All patients who received either a LP capable of providing atrioventricular (AV) synchronous pacing or a permanent pacemaker (PPM) with a LBBAP lead (lumenless or stylet-driven leads) for AV block between January 2021 and January 2023 at a single center were screened. Patients were included in the final analysis if they had both a pre- and post-operative transthoracic echocardiogram, pre- and post-operative electrocardiograms, and a pacing burden of ≥ 20%. The incidence of PICM, defined as a decrease in the left ventricular ejection fraction (LVEF) by ≥ 20% and to a value < 50% after a follow-up of at least six months, was compared between LBBAP and LP groups.
Over the study period, 533 PPMs were implanted for AV block. Of these, 95 patients met the inclusion criteria; 70 underwent LBBAP and 25 received LPs. The average age of the population was 75 ± 13 years; 64 (63%) were men. There was no difference in the mean pre-operative LVEF (57% ± 16% vs. 61% ± 10%; p = 0.25) or QRS duration (123 ± 33ms vs. 130 ± 29ms) between the LBBAP and LP groups. There was a high burden of ventricular pacing in both groups (90% ± 19% vs. 92% ± 13%; p = 0.52). After a follow-up of 14 ± 8 months, the incidence of PICM was significantly lower in the LBBAP group compared to the LP group (4.3% vs. 24%; p = 0.0039).
In patients who are not candidates for cardiac resynchronization, who require a high burden of ventricular pacing, LBBAP may lead to a lower incidence of PICM than right ventricular septal pacing with a LP.
慢性右心室（RV）起搏患者有发生起搏诱导性心肌病（PICM）的风险。关于使用无导线起搏器（LP）起搏RV间隔时PICM发生率的数据有限。左束支区域起搏（LBBAP）已成为RV起搏的一种可行替代方法，PICM发生率较低。
筛选2021年1月至2023年1月在单一中心接受能够提供房室（AV）同步起搏的LP或带有LBBAP导线（无腔或探条驱动导线）的永久性起搏器（PPM）治疗AV阻滞的所有患者。如果患者同时有术前和术后经胸超声心动图、术前和术后心电图，且起搏负担≥20%，则纳入最终分析。比较LBBAP组和LP组中PICM的发生率，PICM定义为在至少6个月的随访后左心室射血分数（LVEF）降低≥20%且降至<50%。
在研究期间，533台PPM被植入用于治疗AV阻滞。其中，95例患者符合纳入标准；70例行LBBAP，25例接受LP。总体平均年龄为75±13岁；64例（63%）为男性。LBBAP组和LP组术前平均LVEF（57%±16%对61%±10%；p=0.25）或QRS时限（123±33ms对130±29ms）无差异。两组心室起搏负担均较高（90%±19%对92%±13%；p=0.52）。在14±8个月的随访后，LBBAP组PICM发生率显著低于LP组（4.3%对24%；p=0.0039）。
对于不适合心脏再同步治疗、需要高心室起搏负担的患者，LBBAP可能比使用LP进行右心室间隔起搏导致更低的PICM发生率。
