Key result
LBBAP is linked to a ~47 ms shorter QRS duration and improved repolarization versus RVSP.
Why the study?
Although LBBAP has shown clinical benefit over RVSP, intraprocedural comparisons of acute depolarization and repolarization ECG parameters between LBBAP and RVSP in the same patients were needed.
Does left bundle branch area pacing improve acute depolarization and repolarization electrocardiographic parameters compared to right ventricular septal pacing in patients undergoing pacemaker implantation?
Observational (n=74)
No
Does left bundle branch area pacing improve acute depolarization and repolarization electrocardiographic parameters compared to right ventricular septal pacing in patients undergoing pacemaker implantation?
p-value: p=<0.001
LBBAP preserves physiological ventricular depolarization and repolarization better than conventional RVSP, as evidenced by acute intraprocedural ECG parameters.
Compared with conventional right ventricular septal pacing (RVSP), several studies have shown a net clinical benefit of left bundle branch area pacing (LBBAP) in terms of ejection fraction preservation and reduced hospitalizations for heart failure. The purpose of this study was to compare acute depolarization and repolarization electrocardiographic parameters between LBBAP and RVSP in the same patients during the LBBAP implant procedure. We prospectively included 74 consecutive patients subjected to LBBAP from 1 January to 31 December 2021 at our institution in the study. After the lead was placed deep into the ventricular septum, unipolar pacing was performed and 12-lead ECGs were recorded from the distal (LBBAP) and proximal (RVSP) electrodes. QRS duration (QRSd), left ventricular activation time (LVAT), right ventricular activation time (RVAT), QT and JT intervals, QT dispersion (QTd), T-wave peak-to-end interval (Tpe), and Tpe/QT were measured for both instances. The final LBBAP threshold was a 0.7 ± 0.31 V at 0.4 ms duration with a sensing threshold of 10.7 ± 4.1 mV. RVSP produced a significantly larger QRS complex than the baseline QRS (194.88 ± 17.29 ms vs. 141.89 ± 35.41 ms, p < 0.001), while LBBAP did not significantly change the mean QRSd (148.10 ± 11.52 ms vs. 141.89 ± 35.41 ms, p = 0.135). LVAT (67.63 ± 8.79 ms vs. 95.89 ± 12.02 ms, p < 0.001) and RVAT (80.54 ± 10.94 ms vs. 98.99 ± 13.80 ms, p < 0.001) were significantly shorter with LBBAP than with RVSP. Moreover, all the repolarization parameters studied were significantly shorter in LBBAP than in RVSP (QT—425.95 ± 47.54 vs. 487.30 ± 52.32; JT—281.85 ± 53.66 vs. 297.69 ± 59.02; QTd—41.62 ± 20.07 vs. 58.38 ± 24.44; Tpe—67.03 ± 11.19 vs. 80.27 ± 10.72; and Tpe/QT—0.158 ± 0.028 vs. 0.165 ± 0.021, p < 0.05 for all), irrespective of the baseline QRS morphology. LBBAP was associated with significantly better acute depolarization and repolarization electrocardiographic parameters compared with RVSP.
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Pestrea et al. (2023) conducted an observational in Patients subjected to LBBAP (n=74). Left bundle branch area pacing (LBBAP) vs. Right ventricular septal pacing (RVSP) was evaluated on Acute depolarization and repolarization electrocardiographic parameters (p=<0.001). Left bundle branch area pacing resulted in significantly shorter QRS duration (148.10 vs 194.88 ms, p<0.001) and improved repolarization parameters compared with right ventricular septal pacing.
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