{"title":"Comparison of Clinical Complications Between LBBAP and Traditional RVP in Long-Term Follow-Up.","authors":"Jieruo Chen, Zefeng Wang, Fei Hang, Yongquan Wu","doi":"10.18087/cardio.2025.1.n2809","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Traditional right ventricular pacing (RVP) can lead to asynchronous cardiac mechanical contractions and increase the risk of adverse cardiac events. This study aimed to compare the clinical complications between left bundle branch area pacing (LBBAP), which is both novel and physiological, and RVP in a cohort requiring ventricular pacing.</p><p><strong>Material and methods: </strong>A retrospective study was conducted on patients with initial implantation of a dual-chamber, permanent pacemaker and with ventricular pacing proportion more than 20 % from January 2019 to December 2020. Patients were divided into the LBBAP or RVP group and follow-up was conducted routinely. The primary outcome was ventricular lead complications, including an increase in the ventricular lead threshold or a decrease in R-wave amplitude. Overall complications were defined as ventricular lead complications, ventricular lead dislocation, ventricular lead perforation, adverse cardiovascular events and cardiovascular death.</p><p><strong>Results: </strong>A total of 248 patients were included in the analysis (LBBAP, n=98; RVP, n=150). The pacing QRS duration in LBBAP patients was significantly shorter than in RVP patients (110.3±22.7 vs 140.0±29.3 ms, p<0.01). For a mean follow-up duration of 13 mos, the risk of ventricular lead complications was higher in the LBBAP group than in the RVP group (62.0 % vs. 36.5 %, p=0.03). LBBAP was comparable to RVP within one year follow-up when considering overall complications. At the one year follow-up ultrasound examinations, the LA in LBBAP group was decreased (p=0.04). Considering the larger initial left ventricular end-diastolic diameter (LVEDD) in the LBBAP group, the similarity of LVEDD values in both groups at follow-up suggested that LVEDD was reduced in patients treated with LBBAP. There was no difference in left ventricular ejection fraction (LBBAP LVEF, baseline = 61.2±8.6 %) between the two groups at baseline or follow-up.</p><p><strong>Conclusions: </strong>LBBAP patients were more prone to ventricular lead threshold increase and amplitude decrease than RVP patients. The risk of overall complications in the two pacing modalities were equal in one year follow-up duration. LBBAP is safe and effective in patients with VP>20 % and without seriously depressed LVEF.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"65 1","pages":"27-33"},"PeriodicalIF":0.5000,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Kardiologiya","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.18087/cardio.2025.1.n2809","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Traditional right ventricular pacing (RVP) can lead to asynchronous cardiac mechanical contractions and increase the risk of adverse cardiac events. This study aimed to compare the clinical complications between left bundle branch area pacing (LBBAP), which is both novel and physiological, and RVP in a cohort requiring ventricular pacing.
Material and methods: A retrospective study was conducted on patients with initial implantation of a dual-chamber, permanent pacemaker and with ventricular pacing proportion more than 20 % from January 2019 to December 2020. Patients were divided into the LBBAP or RVP group and follow-up was conducted routinely. The primary outcome was ventricular lead complications, including an increase in the ventricular lead threshold or a decrease in R-wave amplitude. Overall complications were defined as ventricular lead complications, ventricular lead dislocation, ventricular lead perforation, adverse cardiovascular events and cardiovascular death.
Results: A total of 248 patients were included in the analysis (LBBAP, n=98; RVP, n=150). The pacing QRS duration in LBBAP patients was significantly shorter than in RVP patients (110.3±22.7 vs 140.0±29.3 ms, p<0.01). For a mean follow-up duration of 13 mos, the risk of ventricular lead complications was higher in the LBBAP group than in the RVP group (62.0 % vs. 36.5 %, p=0.03). LBBAP was comparable to RVP within one year follow-up when considering overall complications. At the one year follow-up ultrasound examinations, the LA in LBBAP group was decreased (p=0.04). Considering the larger initial left ventricular end-diastolic diameter (LVEDD) in the LBBAP group, the similarity of LVEDD values in both groups at follow-up suggested that LVEDD was reduced in patients treated with LBBAP. There was no difference in left ventricular ejection fraction (LBBAP LVEF, baseline = 61.2±8.6 %) between the two groups at baseline or follow-up.
Conclusions: LBBAP patients were more prone to ventricular lead threshold increase and amplitude decrease than RVP patients. The risk of overall complications in the two pacing modalities were equal in one year follow-up duration. LBBAP is safe and effective in patients with VP>20 % and without seriously depressed LVEF.
背景：传统的右心室起搏（RVP）可导致非同步心脏机械收缩，增加心脏不良事件的风险。本研究旨在比较左束分支区域起搏（LBBAP）的临床并发症，这是一种新颖的生理起搏，与RVP在需要心室起搏的队列中的临床并发症。材料与方法：回顾性研究2019年1月至2020年12月首次植入双腔永久性起搏器且心室起搏比例大于20%的患者。将患者分为LBBAP组和RVP组，常规随访。主要结局是心室导联并发症，包括心室导联阈值升高或r波振幅降低。总的并发症定义为心室导联并发症、心室导联脱位、心室导联穿孔、不良心血管事件和心血管死亡。结果：共有248例患者被纳入分析(LBBAP, n=98；RVP, n = 150)。LBBAP患者起搏QRS持续时间明显短于RVP患者（110.3±22.7 ms vs 140.0±29.3 ms, p<0.01）。在平均13个月的随访时间中，LBBAP组发生心室导联并发症的风险高于RVP组（62.0% vs 36.5%, p=0.03）。考虑到总体并发症，LBBAP与RVP在1年随访期间相当。随访1年超声检查，LBBAP组LA降低（p=0.04）。考虑到LBBAP组初始左室舒张末期直径（LVEDD）较大，随访时两组LVEDD值相似，提示LBBAP治疗患者LVEDD降低。两组左室射血分数（LBBAP LVEF，基线= 61.2±8.6%）在基线和随访时均无差异。结论：LBBAP患者比RVP患者更容易出现心室导联阈值升高和幅度降低。在一年的随访期间，两种起搏方式的总并发症风险相等。LBBAP对于vp20 %且无严重LVEF下降的患者是安全有效的。
期刊介绍：
“Kardiologiya” (Cardiology) is a monthly scientific, peer-reviewed journal committed to both basic cardiovascular medicine and practical aspects of cardiology.
As the leader in its field, “Kardiologiya” provides original coverage of recent progress in cardiovascular medicine. We publish state-of-the-art articles integrating clinical and research activities in the fields of basic cardiovascular science and clinical cardiology, with a focus on emerging issues in cardiovascular disease. Our target audience spans a diversity of health care professionals and medical researchers working in cardiovascular medicine and related fields.
The principal language of the Journal is Russian, an additional language – English (title, authors’ information, abstract, keywords).
“Kardiologiya” is a peer-reviewed scientific journal. All articles are reviewed by scientists, who gained high international prestige in cardiovascular science and clinical cardiology. The Journal is currently cited and indexed in major Abstracting & Indexing databases: Web of Science, Medline and Scopus.
The Journal''s primary objectives
Contribute to raising the professional level of medical researchers, physicians and academic teachers.
Present the results of current research and clinical observations, explore the effectiveness of drug and non-drug treatments of heart disease, inform about new diagnostic techniques; discuss current trends and new advancements in clinical cardiology, contribute to continuing medical education, inform readers about results of Russian and international scientific forums;
Further improve the general quality of reviewing and editing of manuscripts submitted for publication;
Provide the widest possible dissemination of the published articles, among the global scientific community;
Extend distribution and indexing of scientific publications in major Abstracting & Indexing databases.
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