Key result
LBBAP linked to ~59% lower precordial activation delay and more physiological ventricular activation versus RVP.
Why the study?
Evaluating the effects of RVP and LBBAP requires a deeper understanding of activation sequences beyond standard QRS duration, to better address pacing-induced ventricular dyssynchrony in bradycardic patients.
Does left bundle branch area pacing improve ventricular activation sequences and precordial activation delay compared to right ventricular pacing in bradycardic patients with physiological conduction?
Observational (n=64)
No
Does left bundle branch area pacing improve ventricular activation sequences and precordial activation delay compared to right ventricular pacing in bradycardic patients with physiological conduction?
Absolute Event Rate: 12% vs 29%
p-value: p=<0.01
In bradycardic patients with normal baseline conduction, left bundle branch area pacing preserves physiological ventricular activation synchrony significantly better than conventional right ventricular pacing.
LBBAP was associated with more physiological activation than RVP; hypothesis-generating and requires randomized confirmation before practice change.
Left bundle branch area pacing (LBBAP) has been proposed as a novel physiological pacing modality to overcome ventricular dyssynchrony reported in bradycardic patients who undergo conventional right ventricular pacing (RVP).The standard non-invasive measure of depolarization synchrony is the QRS duration.However, a deeper understanding of not only the activation time but also the activation sequence is required to evaluate the effects of RVP and LBBAP in bradycardic patients.This study aimed to characterize and compare the ventricular activation sequences obtained from both pacing techniques, LBBAP and RVP, by analyzing the standard 12-lead ECGs of bradycardic patients with physiological conduction.22 RVP and 42 LBBAP ECG recordings were collected before and after pacemaker implantation.High (HF) and low (LF) frequency-based methods for QRS complex analysis were used and the precordial activation sequence and activation delay (pAD) were estimated.Results showed more physiological activation sequences after LBBAP than after RVP, with lower pAD (p<0.01) after LBBAP [HF:12(-2,15) vs 29(6,56); LF:9 (-25,13) vs 31(17,38)].The proposed ECG methodology could be used in clinical practice to map more physiological pacing targets in pacemaker implantation.
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Bellés et al. (2023) conducted an observational in Bradyarrhythmias with physiological conduction (n=64). Left bundle branch area pacing (LBBAP) vs. Right ventricular pacing (RVP) was evaluated on Precordial activation delay (pAD) using high-frequency QRS analysis (p=<0.01). Left bundle branch area pacing generated more physiological ventricular activation sequences with significantly lower precordial activation delay compared to right ventricular pacing (12 ms vs 29 ms, p<0.01).
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