Bertini Matteo, Vitali Francesco, Malagù Michele, Azzolini Giorgia, Clò Stefano, Canovi Luca, Farina Jacopo, Bianchi Nicola, De Raffele Martina, Bianchi Chiara, De Pietri Marco, Guidi Colombi Gabriele, Micillo Marco, Melpignano Angelo, Pavasini Rita, Balla Cristina, Guardigli Gabriele, Vijayaraman Pugazhendhi, Zuin Marco
Cardiology Unit, Department of Translational Medicine, Sant'Anna University Hospital, University of Ferrara, Ferrara, Italy.
Cardiology Unit, Department of Translational Medicine, Sant'Anna University Hospital, University of Ferrara, Ferrara, Italy.
JACC Clin Electrophysiol. 2025 Aug;11(8):1852-1861. doi: 10.1016/j.jacep.2025.03.037. Epub 2025 May 28.
The relationship between left ventricular (LV) mechanical efficiency and various modalities of left bundle branch area pacing (LBBAP) is not well understood.
The goal of this study was to evaluate the correlation between 2 different modalities of LBBAP, including left bundle branch pacing (LBBP) and LV septal pacing (LVSP) and myocardial work (MW), during spontaneous rhythm and LBBAP in patients with normal or moderately reduced LV ejection fraction.
Patients were retrieved from the TREEBEARD (Evaluation of Contemporary Cardiac Stimulation in Clinical Practice: Left, Biventricular, Right, and Conduction System Pacing; NCT06324682) prospective study and categorized into 2 groups based on whether they received LBBP or LVSP. MW was assessed using metrics such as global work index, global constructive work, global wasted work, and global work efficiency.
Overall, 155 patients were included in the study (mean age 73.3 ± 14.3 years; 74.8% male), with 102 in the LBBP group and 53 in the LVSP group. In the LBBP group, all MW indices displayed a strong correlation between values recorded during spontaneous rhythm and LBBP. Conversely, the LVSP group exhibited moderate correlations for global work index (r = 0.535; P = 0.004), global constructive work (r = 0.587; P = 0.009), and global work efficiency (r = 0.503; P = 0.01). Global wasted work did not show a statistically significant correlation (r = 0.641; P = 0.13).
In patients with preserved or moderately reduced LV ejection fraction, LBBP exhibited LV mechanical efficiency comparable to that of spontaneous LV activation. Conversely, LVSP is a valuable option, but LV mechanics is impaired, showing a reduced GWE of the left ventricle. (Evaluation of Contemporary Cardiac Stimulation in Clinical Practice: Left, Biventricular, Right, and Conduction System Pacing [TREEBEARD]; NCT06324682).
左心室（LV）机械效率与左束支区域起搏（LBBAP）的各种方式之间的关系尚不清楚。
本研究的目的是评估两种不同方式的LBBAP（包括左束支起搏[LBBP]和左心室间隔起搏[LVSP]）与心肌做功（MW）之间的相关性，这些患者的左心室射血分数正常或中度降低，分别处于自身心律和LBBAP状态。
从TREEBEARD（临床实践中当代心脏刺激的评估：左、双心室、右和传导系统起搏；NCT06324682）前瞻性研究中选取患者，并根据他们接受的是LBBP还是LVSP分为两组。使用诸如整体做功指数、整体建设性做功、整体浪费做功和整体做功效率等指标评估MW。
总体而言，155例患者纳入本研究（平均年龄73.3±14.3岁；74.8%为男性），其中LBBP组102例，LVSP组53例。在LBBP组中，所有MW指标在自身心律和LBBP期间记录的值之间显示出强烈的相关性。相反，LVSP组在整体做功指数（r = 0.535；P = 0.004）、整体建设性做功（r = 0.587；P = 0.009）和整体做功效率（r = 0.503；P = 0.01）方面表现出中等相关性。整体浪费做功未显示出统计学上的显著相关性（r = 0.641；P = 0.13）。
在左心室射血分数保留或中度降低的患者中，LBBP表现出与左心室自发激活相当的左心室机械效率。相反，LVSP是一种有价值的选择，但左心室力学受损，表现为左心室的整体做功效率降低。（临床实践中当代心脏刺激的评估：左、双心室、右和传导系统起搏[TREEBEARD]；NCT06324682）
