Key result
LBBAP linked to ~4 mmHg greater acute SBP drop vs. RVP.
Why the study?
While arterial blood pressure changes after right ventricular pacing have been explored, the relationship between left bundle branch area pacing and blood pressure variations remained unknown.
Does left bundle branch area pacing reduce acute systolic blood pressure more than right ventricular pacing in patients undergoing permanent pacemaker implantation for bradycardia?
Cohort (n=898)
No
Does left bundle branch area pacing reduce acute systolic blood pressure more than right ventricular pacing in patients undergoing permanent pacemaker implantation for bradycardia?
Effect estimate: MD 4.0 (95% CI 2.9-5.2)
Absolute Event Rate: 11.6% vs 7.6%
p-value: p=<0.001
Permanent pacemaker implantation causes an acute decrease in systolic blood pressure, which is significantly more pronounced with physiological left bundle branch area pacing compared to traditional right ventricular pacing.
Greater acute SBP reduction with LBBAP versus RVP should not yet change practice; leaves open long-term effects in bradycardia pacing.
Background: Several previous studies have explored the potential arterial blood pressure (BP) changes in patients undergoing right ventricular pacing (RVP), however, the relationship between left bundle branch area pacing (LBBAP) and BP variations remains unknown. This study aimed to examine the acute BP variations following LBBAP and RVP implantation in patients with bradycardia. Methods: We conducted a single-center retrospective study including all patients who underwent de-novo dual-chamber pacemaker implantation between January 2019 and June 2021. Patients were divided into two groups, LBBAP and RVP, and propensity score-matching (PSM) was used to balance confounding factors. Three time periods were defined according to the timing of the implant: baseline (within 24 hours before implantation), hyper-acute period (0–24 hours post-implantation), and acute period (24–48 hours post-implantation). BP was measured at least three times per period using an arm pressure cuff and then averaged for analysis, which allowed us to determine the acute impact of pacemaker implantation on BP. Results: From a cohort of 898 patients, 193 LBBAP receivers were matched to 193 RVP receivers. A significant decrease in systolic BP (SBP) after the implantation was observed in the study cohort, from baseline 137.3 ± 9.2 mmHg to the acute period of 127.7 ± 9.4 mmHg (p < 0.001). The LBBAP group exhibited a greater SBP reduction than the RVP group (Δ11.6 ± 6.2 mmHg vs. Δ7.6 ± 5.8 mmHg, p < 0.001). In further subgroup analysis, LBBAP receivers who had high baseline SBP (p < 0.001) and those without using anti-hypertensive drugs (p = 0.045) appeared to have a higher magnitude of SBP reduction. Conclusions: Permanent pacemaker implantation may contribute to an acute decrease in systolic BP, which was more pronounced in LBBAP receivers. Future experimental and clinical investigations are necessary to explore the underlying mechanisms and the long-term hemodynamic effects of LBBAP versus RVP.
No takes yet. Share an insight, caveat, or question.
Wu et al. (2023) conducted a cohort in Bradycardia or high-grade atrioventricular block requiring pacemaker (n=898). Left bundle branch area pacing (LBBAP) vs. Right ventricular pacing (RVP) was evaluated on Acute change in systolic blood pressure (SBP) from baseline to 24-48 hours post-implantation (MD 4.0, 95% CI 2.9-5.2, p=<0.001). Left bundle branch area pacing contributed to a significantly greater acute reduction in systolic blood pressure compared to right ventricular pacing (11.6 vs. 7.6 mmHg) in patients undergoing permanent pacemaker implantation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: