Relationship of different left bundle branch pacing sites and clinical outcomes in patients with heart failure

IF 5.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart rhythm Pub Date : 2024-09-02 DOI:10.1016/j.hrthm.2024.08.059

Wen Liu PhD , Zibire· fulati PhD , Fangyan Tian PhD , Nuo Xu PhD , Yufei Cheng PhD , Yingjie Zhao MD , Haiyan Chen PhD , Xianhong Shu PhD

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Abstract

Background

Left bundle branch pacing (LBBP) is a novel physiological pacing modality. However, whether it delivers comparable efficacy with different capture sites in patients with heart failure remains unclear.

Objective

This study aimed to assess the association between different pacing sites and the response of LBBP.

Methods

Forty-three consecutive patients with heart failure, referred for successful LBBP implantation, were prospectively recruited in this study. Patients were assigned to 3 subgroups according to the paced QRS complex morphology (left bundle branch trunk pacing [LBTP], left posterior fascicular pacing, or left anterior fascicular pacing groups). Echocardiograms and electrocardiograms were recorded and analyzed at baseline and 6-month follow-up.

Results

The response rate was 95.0%, 88.2%, and 83.3% in LBTP, left posterior fascicular pacing, and left anterior fascicular pacing groups, respectively. All subgroups were efficient in narrowing the QRS complex (QRS complex narrowing: 38.1 ± 10.8 ms, 36.4 ± 12.6 ms, and 40.8 ± 10.8 ms) and improving cardiac function (LVEF improvement： 25.7% ± 8.1%, 15.3% ± 8.1%, and 18.8% ± 4.4%). Compared with left fascicular pacing, LBTP resulted in longer peak left ventricular activation time (76.5 ± 10.2 ms vs 82.3 ± 6.5 ms; P = .037) and shorter duration from intrinsicoid deflection in V1 or V2 to QRS end (128.0 ± 6.0 ms vs 113.3 ± 5.2 ms; P＜.0001), along with better improvement in septal systolic longitudinal strain (P = .007) and lateral-septal myocardial loading inhomogeneity (P = .036). Linear regression analysis further revealed that left bundle branch capture sites were strongly associated with the improvement in peak strain dispersion (model R² = 0.586; P = .042) and LVEF (model R² = 0.425; P < .0001).

Conclusion

Different left bundle branch capture sites led to a subtle difference in mechanical synchrony, which may, in turn, affect LVEF improvement in patients with heart failure.

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不同左束支起搏点与心衰患者临床疗效的关系

背景：左束支起搏（LBBP）是一种新型的生理起搏方式。然而，在心力衰竭（HF）患者中，不同的捕获部位是否具有可比疗效仍不清楚：本研究旨在评估不同起搏部位与 LBBP 反应之间的关联：本研究前瞻性地招募了43名成功植入LBBP的连续心衰患者。根据起搏QRS波群形态将患者分为3个亚组（左束支干起搏组（LBTP）、左后筋膜起搏组（LPFP）或左前筋膜起搏组（LAFP））。记录并分析了基线和6个月随访时的超声心动图和心电图：结果：LBTP、LPFP 和 LAFP 组的响应率分别为 95.0%、88.2% 和 83.3%。所有亚组在缩小 QRS 波群（ΔQRS：62.4±10.4 ms、54.7±14.2 ms、58.2±14.5 ms）和改善心功能（ΔLVEF：25.7±8.1%、15.3±8.1%、18.8±4.4%）方面均有效。与左束起搏（LFP）相比，LBTP 使 LVAT 更长（76.5±10.2ms vs 82.3±6.5ms；P=0.037），QRSid 更短（128.0±6.0ms vs 113.3±5.2ms；P＜0.0001），室间隔收缩期纵向应变（P=0.007）和侧隔心肌负荷不均匀性（P=0.036）得到更好的改善。线性回归分析进一步显示，LBB捕获部位与峰值应变弥散（PSD）（模型R2=0.586，P=0.042）和LVEF（模型R2=0.425，P 结论）的改善密切相关：不同的 LBB 捕获部位会导致机械同步性的细微差别，进而影响心房颤动患者 LVEF 的改善。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.