Left bundle branch area pacing maintained right ventricular fractional area change at 50.81% compared to 45.43% with right ventricular septal pacing and 44.29% with apical pacing at 1 year.
Cohort (n=90)
Single-blind
No
Does left bundle branch area pacing preserve right heart structure, function, and interventricular synchrony compared to right ventricular septal or apical pacing in pacemaker-dependent patients with normal LVEF?
Left bundle branch area pacing preserves right ventricular function and improves interventricular synchrony compared to right ventricular septal or apical pacing at 1-year follow-up.
Absolute Event Rate: 50.81% vs 45.43%
p-value: p=0.006
Background: Left bundle branch area pacing (LBBAP) has evolved into a practical and secure pacing procedure. However, previous studies of LBBAP focused on left heart function and synchronization and lacked assessment of right heart structure and function and interventricular synchrony. The objective of this study was to examine the impacts of LBBAP, right ventricular (RV) septal pacing (RVSP), and RV apical pacing (RVAP) on right heart structure, function and interventricular synchrony. Methods: Between January and July 2021, A total of 90 patients exhibited a normal left ventricular (LV) ejection fraction and received dual chamber pacemaker implantation for bradycardia at Beijing Anzhen Hospital. The patients were assigned to three groups based on the pacing site: LBBAP, RVSP, or RVAP. RV function was evaluated using right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler–derived tricuspid lateral annular systolic velocity (S'), right ventricular myocardial performance index (RVMPI), global longitudinal strain of the right ventricle (GLSRV), and right ventricular free wall longitudinal strain (RVFWLS). Tricuspid regurgitation (TR) was assessed using vena contracta magnitude (VCM) and the ratio of TR jet area to right atrial area (RAA). Interventricular mechanical synchrony was evaluated using interventricular mechanical delay (IVMD) and left ventricular to right ventricular time-to-peak standard deviation (LV-RV TPSD). Results: Baseline echocardiographic parameters and characteristics were comparable among the three groups. No significant differences were observed in the LBBAP group from baseline to follow-up for QRS duration (p = 0.783), TAPSE (p = 0.122), RVFAC (p = 0.679), RVMPI (p = 0.93), GLSRV (p = 0.511), RVFWLS (p = 0.939), VCM (p = 0.467), and TR jet area/RAA (p = 0.667). In contrast, a significant decline was observed in the RVAP group (all p 0.05). However, there were significant differences in RVFAC (p = 0.009), RVMPI (p = 0.037), TRVCM (p = 0.046), and TR jet area/RAA (p = 0.033) in the RVSP group. Moreover, compared to baseline, a 1-year follow-up showed that LBBAP significantly reduced IVMD (from 17.3 ± 26.5 ms to 8.6 ± 7.1 ms, p < 0.05) and LV-RV TPSD from 16.41 (8.81–42.5) to 12.28 (5.64–23.7), p < 0.05, while RVSP and RVAP worsened IVMD and LV-RV TPSD (all p < 0.05). Conclusions: Compared with RVSP or RVAP, LBBAP can maintain RV function and improve electrical and interventricular synchrony, with limited TR deterioration after a 1-year follow-up. Clinical Trial Registration: No. ChiCTR2100048503, https://www.chictr.org.cn/showproj.html?proj=129290.
Mei et al. (Wed,) conducted a cohort in Pacemaker-dependent bradycardia (n=90). Left bundle branch area pacing (LBBAP) vs. Right ventricular septal pacing (RVSP) or right ventricular apical pacing (RVAP) was evaluated on Right ventricular fractional area change (RVFAC) at 1 year (p=0.006). Left bundle branch area pacing maintained right ventricular fractional area change at 50.81% compared to 45.43% with right ventricular septal pacing and 44.29% with apical pacing at 1 year.