Key result
Presence of LBB potential during LBBP is linked to a ~10 ms narrower paced QRS.
Why the study?
The relation between left bundle branch potential and left ventricular electrical and mechanical synchrony in bradycardia patients without heart failure receiving left bundle branch pacing was unclear.
Does the presence of left bundle branch potential during left bundle branch pacing improve left ventricular electrical and mechanical synchrony in bradycardia patients without heart failure?
Cohort (n=62)
No
Does the presence of left bundle branch potential during left bundle branch pacing improve left ventricular electrical and mechanical synchrony in bradycardia patients without heart failure?
Absolute Event Rate: 113.5% vs 123.4%
p-value: p=0.031
While achieving LBB potential during LBBP improves electrical synchrony, it does not improve mechanical synchrony and increases procedure and fluoroscopy times, suggesting it may not be necessary to deliberately pursue it if difficult.
May not warrant deliberate pursuit of left bundle branch potential if difficult; leaves open effects on mechanical synchrony and outcomes.
BACKGROUND: Left bundle branch pacing (LBBP) is a novel physiological pacing technology. We aim to explore the relation between LBB potential (LBB Po) and left ventricular (LV) electrical/mechanical synchrony in bradycardia patients without heart failure (HF) receiving LBBP. METHODS: A total of 62 patients undergoing LBBP were categorized by LBB Po: the LBB Po positive (+) group and the LBB Po negative (-) group. The perioperative electrocardiographic and echocardiography parameters related to cardiac synchrony were analyzed. RESULTS: There were 42 (67.74%) patients in the LBB Po (+) group and 20 patients in the LBB Po (-) group. Paced QRS duration (113.50 ± 17.65 ms vs. 123.40 ± 13.18 ms, P = 0.031) and stimulus left ventricular activation time (71.76 ± 3.53 ms vs. 74.45 ± 3.12 ms, P = 0.005) were shorter in the LBB Po (+) group than in the LBB Po (-) group. No significant differences in the LV mechanical synchrony (Ts-SD-12, 36.55 ± 19.76 vs. 39.95 ± 16.04, P = 0.505; PSD, 51.14 ± 17.69 vs. 45.65 ± 10.55, P = 0.205) between the two groups. There was not statistically difference in ventricular lead parameters measured intraoperative between the two groups. Compared with the LBB Po (-) group, the LBB Po (+) group showed a dramatically higher total procedure duration time (93.52 ± 9.18 min vs. 86.25 ± 10.54 min, p = 0.007) and fluoroscopy time for ventricle lead implantation (18.95 ± 3.43 min vs. 14.00 ± 3.16 min, p < 0.001). CONCLUSIONS: The appearance of LBB Po may suggest better electrical synchrony during LBBP, but similar in LV mechanical synchrony. However, the total operation duration and fluoroscopy time of ventricular lead implantation in the LBB Po (+) group were longer. Therefore, it may be unnecessary to deliberately recognize the LBB Po when it is difficult to detect LBB Po and meet the LBBP criterion.
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Huang et al. (2022) conducted a cohort in Symptomatic bradycardia without heart failure (n=62). Left bundle branch pacing with LBB potential vs. Left bundle branch pacing without LBB potential was evaluated on Paced QRS duration (p=0.031). In bradycardia patients receiving left bundle branch pacing, the presence of left bundle branch potential was associated with a narrower paced QRS duration (113.50 vs. 123.40 ms) and shorter stimulus left ventricular activation time.
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