Why the study?
LBBP has emerged as an alternative physiological pacing technique to HBP, but cardiac electrical and mechanical synchrony comparing LBBP and HBP in permanent AF had not been evaluated.
Does left bundle branch pacing achieve similar cardiac electrical and mechanical synchronization compared to His bundle pacing in patients with permanent atrial fibrillation?
Does left bundle branch pacing achieve similar cardiac electrical and mechanical synchronization compared to His bundle pacing in patients with permanent atrial fibrillation?
In patients with permanent atrial fibrillation, left bundle branch pacing achieves similar left and right ventricular mechanical synchrony to His bundle pacing, though with a modest delay in right ventricular activation.
LBBP achieves comparable LV synchrony to HBP in permanent AF; leaves open whether modest RV delay affects clinical outcomes.
BACKGROUND: His bundle pacing (HBP) is a physiological pacing strategy to preserve the electrical synchrony of ventricular conduction and left ventricular (LV) function. Left bundle branch pacing (LBBP) has emerged as an alternative physiological pacing technique. OBJECTIVE: To evaluate cardiac electrical and mechanical synchrony comparing LBBP and HBP in patients with permanent atrial fibrillation (AF). METHODS: Consecutive patients with symptomatic bradycardia and AF were enrolled from January to June of 2019. The cardiac electrical and mechanical synchrony in different pacing mode were evaluated at baseline and after implantation. RESULTS: Both HBP and LBBP were performed in 20 patients. LBBP significantly widened the QRS duration compared with the intrinsic conduction (113.2 ± 14.5 vs. 96.5 ± 16.2 ms; p = .01), while HBP did not (104.5 ± 22.3 vs. 96.5 ± 16.2 ms; p = .12). Both LBBP and HBP patients had similar LV myocardial strain measurements for the mechanical synchrony evaluation without significant change compared with baseline. There was no significant difference in right ventricular synchrony measurement between LBBP and HBP. Compared to HBP, LBBP had less interventricular synchrony (IMVD, 14.7 ± 9.2 vs. 3.1 ± 12.7 ms, p < .01; Ts-LV-RV, 37.9 ± 10.7 vs. 18.5 ± 10.8 ms, p < .001). CONCLUSIONS: Although LBBP's a physiological pacing mode can achieve a similar cardiac electrical and mechanical synchronization when compared to HBP, LBBP results in modest delay in RV activation, and the clinical implication remains to be studied.
No takes yet. Share an insight, caveat, or question.
Sheng et al. (2021) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: