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Feasibility and stability of left bundle branch pacing in patients after prosthetic valve implantation.

ABSTRACT: BACKGROUND:Left bundle branch pacing (LBBP) has emerged as a promising pacing modality for preventing pacing induced cardiomyopathy in patients complicated with conduction abnormalities (CAs) after prosthetic valve (PV) implantation. OBJECTIVE:The present study aimed to evaluate the safety and feasibility of LBBP in this patient population. METHODS:LBBP was attempted in 20 patients complicated with atrioventricular block after PV implantation. Surface, intracardiac electrical measurements, and echocardiographic data were documented. Lead parameters and complications were routinely tracked at implantation and each follow-up visit. RESULTS:LBBP was successful in 90% (18/20) participants. The paced QRS duration and the stimulus to left ventricular activation time were 106.8 ±?6.8 ms and 65.5 ±?5.4 ms, respectively. Left bundle branch (LBB) potential was recorded in 61.1% (11/18) patients who succeeded in LBBP. During the procedure, the mean unipolar myocardium capture threshold was 0.51?±?0.15?V@0.4 ms while the unipolar bundle capture threshold was 0.84?±?0.51?V@0.4 ms. The mean fluoroscopic exposure time and the radiation dose were 13.0 ±?9.2?min and 81.7 ±?8.3 mGy, respectively. The average follow-up period was 10.4 ±?5.9 months (range 3-23?months). Pacing parameters remained stable and no significant lead-related complications occurred during the whole observation period. CONCLUSIONS:LBBP was safe and feasible in patients with PVs. Acceptable and stable pacing parameters could be expected during the procedure and the follow-ups.

SUBMITTER: Guo J

PROVIDER: S-EPMC7533988 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Feasibility and stability of left bundle branch pacing in patients after prosthetic valve implantation.

Guo Jincun J Li Linlin L Xiao Guosheng G Huang Xinyi X Li Qiang Q Wang Yan Y Cai Binni B

Clinical cardiology 20200701 10

<h4>Background</h4>Left bundle branch pacing (LBBP) has emerged as a promising pacing modality for preventing pacing induced cardiomyopathy in patients complicated with conduction abnormalities (CAs) after prosthetic valve (PV) implantation.<h4>Objective</h4>The present study aimed to evaluate the safety and feasibility of LBBP in this patient population.<h4>Methods</h4>LBBP was attempted in 20 patients complicated with atrioventricular block after PV implantation. Surface, intracardiac electric ...[more]

PMID: 32609400

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Project description:Background: Left bundle branch area pacing (LBBAP) is a novel pacing modality with stable pacing parameters and a narrow-paced QRS duration. We compared heart failure (HF) hospitalization events and echocardiographic measures between LBBAP and right ventricular pacing (RVP) in patients with atrioventricular block (AVB). Methods and Results: This multicenter observational study prospectively recruited consecutive AVB patients requiring ventricular pacing in five centers if they received LBBAP or RVP and had left ventricular ejection fraction (LVEF) >50%. Data on electrocardiogram, pacing parameters, echocardiographic measurements, device complications, and clinical outcomes were collected at baseline and during follow-up. The primary outcome was first episode hospitalization for HF or upgrade to biventricular pacing. LBBAP was successful in 235 of 246 patients (95.5%), while 120 patients received RVP. During a mean of 11.4 ± 2.7 months of follow-up, the ventricular pacing burden was comparable (83.9 ± 35.1 vs. 85.7 ± 30.0%), while the mean LVEF differed significantly (62.6 ± 4.6 vs. 57.8 ± 11.4%) between the LBBAP and RVP groups. Patients with LBBAP had significantly lower occurrences of HF hospitalization and upgrading to biventricular pacing than patients with RVP (2.6 vs. 10.8%, P <0.001), and differences in primary outcome between LBBAP and RVP were mainly observed in patients with ventricular pacing >40% or with baseline LVEF <60%. The primary outcome was independently associated with LBBAP (adjusted HR 0.14, 95% CI: 0.04-0.55), previous myocardial infarction (adjusted HR 6.82, 95% CI: 1.23-37.5), and baseline LVEF (adjusted HR 0.91, 95% CI: 0.86-0.96). Conclusion: Permanent LBBAP might reduce the risk of HF hospitalization or upgrade to biventricular pacing compared with RVP in AVB patients requiring a high burden of ventricular pacing. Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03851315; URL: http://www.chictr.org.cn; Unique Identifier: ChiCTR2100043296.

Dataset Information

Feasibility and stability of left bundle branch pacing in patients after prosthetic valve implantation.

Publications

Feasibility and stability of left bundle branch pacing in patients after prosthetic valve implantation.

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