Key result
Post-implant Tpeak-Tend (TpTe) interval was an independent predictor of echocardiographic response after left bundle branch area pacing (OR 0.887), with patients having TpTe <81.2 ms showing a 93.3% response rate compared to 44.4% in others.
Why the study?
Although LBBAP is effective for heart failure patients needing CRT or ventricular pacing, the response rate is only 70%, and the effects of LBBAP on repolarization parameters and their link to echocardiographic response were unclear.
Does left bundle branch area pacing (LBBAP) improve repolarization parameters, and are these parameters associated with echocardiographic response in heart failure patients?
Cohort (n=59)
Single-blind
No
Does left bundle branch area pacing (LBBAP) improve repolarization parameters, and are these parameters associated with echocardiographic response in heart failure patients?
Answers are grounded in this paper and cite their sources.
Left bundle branch area pacing improves dispersion of ventricular repolarization in heart failure patients, and a shorter post-implant TpTe (<81.2 ms) strongly predicts positive echocardiographic response.
Background: Left bundle branch area pacing (LBBAP) has become a safe and effective option for heart failure (HF) patients indicated for cardiac resynchronization therapy (CRT) and/or ventricular pacing, yet the response rate was only 70%. Repolarization parameters were demonstrated to be associated with cardiac mechanics and systolic function. This study aimed to investigate the effects of LBBAP on repolarization parameters and the potential association between those parameters and echocardiographic response. Methods and results: A total of 59 HF patients undergoing successful LBBAP were consecutively included. QTc, Tpeak-Tend (TpTe), and TpTe/QTc were measured before and after the implantation. The results turned out that the dispersion of ventricular repolarization (DVR) improved after LBBAP among the total population. Although trends of repolarization parameters varied according to different QRS configurations at baseline, the post-implant parameters showed no significant difference between groups. The association between repolarization parameters and LBBAP response was then evaluated among patients with wide QRS. Multivariate analysis demonstrated that post-implant TpTe was the independent predictor of LBBAP response (p < 0.05). Receiver operating characteristic analysis indicated an area under the curve of 0.77 (95% CI, 0.60–0.93) with a cutoff value of 81.2 ms (p < 0.01). Patients with post-implant TpTe<81.2 ms had a significantly higher rate of echocardiographic response (93.3 vs. 44.4%, p < 0.01). Further subgroup analysis indicated that the predictive value of post-implant TpTe for LBBAP response was more significant in non-left bundle branch block (LBBB) patients than in LBBB patients. Conclusion: LBBAP improved DVR significantly in HF patients. Post-implant TpTe was associated with the echocardiographic response after LBBAP among patients with wide QRS, especially for non-LBBB patients.
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Li et al. (2022) conducted a cohort in Heart failure (n=59). Left bundle branch area pacing (LBBAP) vs. Baseline was evaluated on Echocardiographic response (multivariate predictor: post-implant TpTe) (OR 0.887, 95% CI 0.802-0.982, p=<0.05). Post-implant Tpeak-Tend (TpTe) interval was an independent predictor of echocardiographic response after left bundle branch area pacing (OR 0.887), with patients having TpTe <81.2 ms showing a 93.3% response rate compared to 44.4% in others.
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