Briongos-Figuero Sem, Estévez Paniagua Álvaro, Tapia Martínez Manuel, Jiménez Loeches Silvia, Sánchez Hernández Ana, Heredero Palomo Delia, Sánchez López Elena, Luna Cabadas Arantxa, Muñoz-Aguilera Roberto
Cardiology Department. Hospital Infanta Leonor Hospital. Gran Vía del Este, 28030, Madrid, Spain.
Cardiology Department. Hospital Central de la Defensa Gómez Ulla, Glorieta del Ejército, 1, 28047, Madrid, Spain.
Heart Rhythm O2. 2025 Feb 21;6(5):576-587. doi: 10.1016/j.hroo.2025.02.011. eCollection 2025 May.
Physiologic pacing is safe and feasible, but whether electrical synchrony persists at follow-up in patients undergoing left bundle branch area pacing (LBBAP) is unknown.
To determine performance of electrical synchrony in LBBAP patients at follow-up.
Consecutive patients with successful LBBAP for bradycardia pacing indication and preserved left ventricular ejection fraction were selected. At follow-up, a 12-lead electrocardiogram (ECG) was recorded along with echocardiography for myocardial work analysis. V6-R wave peak time (RWPT), V1-RWTP, and QRS duration were compared.
One hundred forty-nine patients were studied. After 18.2 ± 7.3 months, V6-RWTP decreased from 74.4 ± 8.9 milliseconds to 71.5 ± 10.6 milliseconds ( < .001) in LBBP captures and from 90.9 ± 7.2 to 85.7 ± 9.3 milliseconds ( = .011) in left ventricular septal pacing (LVSP) captures. V1-RWPT decreased from 120.5 ± 13.1 to 111.7 ± 11.8 milliseconds at follow-up ( < .001) in LBBP and from 118.6 ± 9.9 to 115.2 ± 12.1 milliseconds ( = .052) in LVSP. Paced QRS duration was also significantly reduced in LBBP (from 115.3 ± 13.6 to 107.6 ± 12.8 milliseconds at follow-up; < .001). At follow-up, 29 patients lost the right bundle branch (RBB) delay pattern in lead V1, but QRS duration remained unchanged (111.3 ± 10.7 at implant vs 109.6 ± 12.5 milliseconds at follow-up; = .413), as did V6-RWPT, in both LBBP (73.4 ± 5.9 at implant vs 73.1 ± 6.9 milliseconds at follow-up; = .860) and LVSP captures (86.3 ± 5.6 at implant vs 85.3 ± 8.1 milliseconds at follow-up; = .658). Mechanical synchrony in patients with and without RBB delay pattern was similar.
In patients undergoing LBBAP for bradycardia pacing, electrical synchrony remained stable over time, suggesting that LBBAP is a reliable and durable method for physiologic pacing.
生理性起搏安全可行，但接受左束支区域起搏（LBBAP）的患者在随访时电同步性是否持续存在尚不清楚。
确定LBBAP患者随访时的电同步性能。
选择因心动过缓起搏指征成功进行LBBAP且左心室射血分数保留的连续患者。随访时，记录12导联心电图（ECG）并进行超声心动图检查以分析心肌做功。比较V6 - R波峰时间（RWPT）、V1 - RWTP和QRS时限。
共研究了149例患者。在18.2±7.3个月后，LBBP夺获时V6 - RWTP从74.4±8.9毫秒降至71.5±10.6毫秒（P <.001），左心室间隔起搏（LVSP）夺获时从90.9±7.2毫秒降至85.7±9.3毫秒（P = 0.011）。随访时，LBBP中V1 - RWPT从120.5±13.1毫秒降至111.7±11.8毫秒（P <.001），LVSP中从118.6±9.9毫秒降至115.2±12.1毫秒（P = 0.052）。LBBP中起搏QRS时限也显著缩短（随访时从115.3±13.6毫秒降至107.6±12.8毫秒；P <.001）。随访时，29例患者V1导联失去右束支（RBB）延迟图形，但QRS时限保持不变（植入时为111.3±10.7毫秒，随访时为109.6±12.5毫秒；P = 0.413），LBBP（植入时73.4±5.9毫秒，随访时73.1±6.9毫秒；P = 0.860）和LVSP夺获（植入时86.3±5.6毫秒，随访时85.3±8.1毫秒；P = 0.658）时的V6 - RWPT也是如此。有和没有RBB延迟图形的患者机械同步性相似。
对于因心动过缓起搏而接受LBBAP的患者，电同步性随时间保持稳定，提示LBBAP是一种可靠且持久的生理性起搏方法。
