Key result
LBBP linked to ~44 ms narrower QRS and improved mechanical synchrony vs RVAP in AVB.
Why the study?
To compare electromechanical ventricular synchrony across different pacing sites and evaluate correlations between electrophysiological characteristics and ventricular synchrony.
Does His-Purkinje conduction system pacing improve electromechanical ventricular synchrony compared to right ventricular pacing in patients with complete atrioventricular block?
Observational (n=20)
Single-blind
No
Does His-Purkinje conduction system pacing improve electromechanical ventricular synchrony compared to right ventricular pacing in patients with complete atrioventricular block?
Absolute Event Rate: 116.15% vs 160.15%
p-value: p=<0.001
His-Purkinje conduction system pacing, particularly left bundle branch pacing, achieves better electrical and mechanical synchrony than conventional right ventricular pacing in patients with complete atrioventricular block.
LBBP may improve synchrony over RV pacing in complete AVB; leaves open randomized outcome confirmation.
Objectives to Background To compare electromechanical ventricular synchrony when pacing from different sites, including right ventricular apex pacing (RVAP), right ventricular septum pacing (RVSP), His bundle pacing (HBP), left bundle branch pacing (LBBP), and RVSP during unipolar pacing from the ring electrode of LBBP lead (RVSP ring ) in each patient and evaluate the correlations between electrophysiological characteristics and ventricular synchrony. Methods Twenty patients with complete atrioventricular block indicated for dual‐chamber pacemaker implantation were included in the study. Unipolar pacing at different sites, including RVAP, RVSP, HBP, LBBP, and RVSP ring , was successively performed in each patient. The pacing characteristics and echocardiogram parameters were collected and compared among intrinsic rhythm and pacing at different sites. Results Similar to HBP (114.84 ± 18.67 ms), narrower paced QRSd was found in LBBP (116.15 ± 11.60 ms) as compared to RVSP ring (135.11 ± 13.68 ms), RVSP (141.65 ± 14.26 ms), and RVAP (160.15 ± 19.35 ms) ( p < .001). LBBP showed comparable pacing parameters to RVAP or RVSP and was significantly better than HBP, with maintained cardiac function. TS‐12‐SD was significantly improved in LBBP (41.80 ± 20.97 ms) than RVAP (69.70 ± 32.42 ms, p = .003) and RVSP (63.30.56 ± 32.53 ms, p = .018) but similar to HBP (51.50 ± 25.67 ms, p = .283) or RVSP ring (57.80 ± 25.65 ms, p = .198). Among these pacing strategies, negative values of interventricular mechanical delay (IVMD) were only identified in LBBP (−19.25 ± 18.43 ms), significantly different from RVAP (35.00 ± 30.72 ms), RVSP (22.85 ± 22.05 ms), HBP (5.20 ± 18.64 ms), and RVSP ring (16.00 ± 26.76 ms (all p < .05). Using Pearson's analysis, Sti‐LVAT was positively correlated with QRS duration, IVMD, TS‐12‐SD, LVEDV, and LVESV, while a negative relationship could be observed for left ventricular ejection fraction. Conclusions His‐Purkinje conduction system pacing (HPCSP) achieved better electrical and mechanical synchrony than conventional RV pacing. For interventricular synchrony, only LBBP initiated earlier LV activation than RV, in accordance with the right bundle branch block (RBBB) pattern of paced QRS during LBBP. Sti‐LVAT might be a good parameter correlating with LV systolic function and mechanical synchrony.
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Chen et al. (2022) conducted an observational in Complete atrioventricular block (n=20). His-Purkinje conduction system pacing (His bundle pacing and left bundle branch pacing) vs. Right ventricular pacing (apex and septum) was evaluated on Paced QRS duration (LBBP vs RVAP) (p=<0.001). Left bundle branch pacing achieved significantly narrower QRS duration (116.15 ms) compared to right ventricular apex pacing (160.15 ms) and improved mechanical synchrony in patients with complete AVB.
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