Mid - term benefits and short - term haemodynamic evaluation by kinocardiography of left bundle branch pacing compared with apical ventricular pacing

Abstract Introduction Left bundle branch pacing (LBBP) is a new stimulation strategy that has been shown to maintain ventricular synchronization compared with conventional right ventricular pacing (RVP). Many studies proved that LBBP is at least as much as efficace than cardiac resynchronization therapy in electrical resynchronization and ejection fraction improvement in heart failure patients. Kinocardiography uses accelerometry and gyroscopy to estimate cardiac haemodynamic with kinetic energy. Purpose The aim was to evaluate the short-term haemodynamic differences between LBBP and RVP using kinocardiography device and mid – term safety and feasibility of LBBP. Methods This study enrolled 64 patients with attempted LBBP from May 2022 to February 2025. Some were enrolled in the prospective part of the study and one minute’s kinocardiographic measurements and non-invasive arterial pressure were made during the implantation when we consecutively stimulated the apex and in LBBP. Parameters, complications and ECG were assessed at implant and during follow – up between 6 weeks and 6 months. Results Among the patients enrolled, 31 were prospectively included (74.81 ± 8.82 years ; 26 men (84%) ; 5 women (16%) ; BMI 29.72 ± 6.25 kg/m2 ; LVEF 55 ± 9 % ). All of them were implanted with a two - chambers LBBP except 3 that underwent single - chamber pacemaker implantation. LBBP was successful in 62 patients and it failed in 2 patients with the lead then positioned in classical apical position. LBBP achieved a significantly narrowed paced QRSd than RVP (110 ± 18 vs 158 ± 14, p 0.001). The pacing thresholds during follow – up were significantly higher than these recorded at implantation (Atrial : 0.73 ± 0.36 vs 0.87 ± 0.59 V, p = 0.005 ; Ventricular : 0.59 ± 0.21 vs 0.82 ± 0.45, p 0.001) but detections and pacing impedances did not differ significantly between the two groups. Haemodynamic parameters In LBBP systolic blood pressure was higher than in RVP (150 ± 24 vs 145 ± 24, p = 0.008). There was no significant systolic blood pressure’s difference in LBBP and spontaneous rhythm (SR). Diastolic blood pressure was significantly higher in LBBP and RVP compared to SR. Kinocardiography Measurements are described in pictures 1 and 2. No significant difference was observed in linear kinetic energy between RVP and LBBP. However, almost every linear measurements in RVP and in LBBP were reduced compared with SR but x –and z –linear energies were similar in LBBP and SR. Compared with RVP, LBBP demonstrated significantly increased total, y – and z- rotational systolic kinetic energy. Rotational diastolic energies did not differ significantly between the three stimulations. Conclusion LBBP is a physiological novel pacing approach that has once again demonstrated his feasibility and stability. Rotational kinetic energies are correlated to LVEF and are higher in one minute’s LBBP stimulation than in RVP stimulation right at the implantationSystolic kinocardiographic parameters Diastolic kinocardiographic parameters