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Glikson M, Burri H, Abdin A, Cano O, Curila K, De Pooter J, Diaz JC, Drossart I, Huang W, Israel CW, Jastrzębski M, Joza J, Karvonen J, Keene D, Leclercq C, Mullens W, Pujol-Lopez M, Rao A, Vernooy K, Vijayaraman P, Zanon F, Michowitz Y. European Society of Cardiology (ESC) clinical consensus statement on indications for conduction system pacing, with special contribution of the European Heart Rhythm Association of the ESC and endorsed by the Asia Pacific Heart Rhythm Society, the Canadian Heart Rhythm Society, the Heart Rhythm Society, and the Latin American Heart Rhythm Society. Europace 2025; 27:euaf050. [PMID: 40159278 PMCID: PMC11957271 DOI: 10.1093/europace/euaf050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2025] [Revised: 03/09/2025] [Accepted: 03/10/2025] [Indexed: 04/02/2025] Open
Abstract
Conduction system pacing (CSP) is being increasingly adopted as a more physiological alternative to right ventricular and biventricular pacing. Since the 2021 European Society of Cardiology pacing guidelines, there has been growing evidence that this therapy is safe and effective. Furthermore, left bundle branch area pacing was not covered in these guidelines due to limited evidence at that time. This Clinical Consensus Statement provides advice on indications for CSP, taking into account the significant evolution in this domain.
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Affiliation(s)
- Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Amr Abdin
- Internal Medicine Clinic III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Oscar Cano
- Unidad de Arritmias, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jan De Pooter
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Juan C Diaz
- Clínica Las Vegas, Universidad CES, Medellín, Colombia
| | - Inga Drossart
- ESC Patient Forum, Sophia Antipolis, France
- European Society of Cardiology, Sophia Antipolis, France
| | - Weijian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Carsten W Israel
- Department of Medicine-Cardiology, Diabetology and Nephrology, Bethel-Clinic, Bielefeld, Germany
| | - Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Jacqueline Joza
- Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Jarkko Karvonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Christophe Leclercq
- Service de Cardiologie et Maladies Vasculaires, Université de Rennes, CHU Rennes, INSERM, LTSI—UMR 1099, F-35000 Rennes, France
| | | | - Margarida Pujol-Lopez
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Archana Rao
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Yoav Michowitz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
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2
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van Koll J, Luermans JGLM, Joza J, Burri H, Curila K, Bressi E, Grieco D, van Kuijk SMJ, Rijks JHJ, van Stipdonk AMW, Smits KC, Prinzen FW, Rademakers LM, Vernooy K, Nguyên UC. Heterogeneity in clinical judgment of septal lead position and capture type in left bundle branch area pacing. Heart Rhythm 2025:S1547-5271(25)02196-4. [PMID: 40107397 DOI: 10.1016/j.hrthm.2025.03.1959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Revised: 02/07/2025] [Accepted: 03/12/2025] [Indexed: 03/22/2025]
Abstract
BACKGROUND Determining capture type and septal lead location during left bundle branch area pacing (LBBAP) relies on criteria obtained during implantation. However, during follow-up, the interpretation of left bundle branch (LBB) capture largely depends on QRS morphology, which is not so straightforward in LBBAP. OBJECTIVE This study aimed to investigate the inter- and intraobserver agreement, as well as the accuracy of clinical judgment of the electrocardiogram (ECG) in determining LBB-capture and septal lead position in patients undergoing LBBAP implantation. In addition, the role of vectorcardiographic QRS-area in determining LBB-capture was evaluated. METHODS Unipolar paced ECGs during LBBAP implantation from 50 patients with baseline narrow QRS were collected. LBB-capture was attempted in all patients and assessed using MELOS (Multicentre European Left Bundle Branch Area Pacing Outcomes Study) criteria and the European Heart Rhythm Association (EHRA) consensus statement. Eight blinded cardiologists classified 100 ECGs for capture type and septal location. RESULTS The interobserver and intraobserver agreement for capture type had a Light's kappa of 0.43 and 0.62, respectively. Concordance between clinical judgment and intraprocedural confirmation averaged 72%. Interobserver and intraobserver agreement for septal lead position had a Light's kappa of 0.43 and 0.77 respectively. QRS-area was significantly higher for left ventricular septal pacing (LVSP) than nsLBBP, whereas QRS duration was not. A QRS-area cutoff of 26 mV.ms had 77% accuracy in distinguishing LVSP from nsLBBP. Clinical judgment accuracy averaged 72%. CONCLUSION Interobserver agreement and correlation with intraprocedural confirmation (gold standard) are only moderate, whereas intraobserver agreement on ECG-based differentiation of capture type and septal lead location is substantial. Vectorcardiographic QRS-area slightly outperforms clinical judgment in distinguishing capture types and may be a useful objective alternative.
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Affiliation(s)
- Johan van Koll
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Justin G L M Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jacqueline Joza
- Department of Medicine, McGill University Health Center, Montréal, Québec, Canada
| | - Haran Burri
- Geneva Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital, Prague, Czech Republic
| | - Edoardo Bressi
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | | | - Sander M J van Kuijk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jesse H J Rijks
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Antonius M W van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Karin C Smits
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Uyên Châu Nguyên
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
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3
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Niazi I. Conduction System Pacing: Where Are We in 2025? J Innov Card Rhythm Manag 2025; 16:6151-6153. [PMID: 39897726 PMCID: PMC11784394 DOI: 10.19102/icrm.2025.16015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Accepted: 11/17/2024] [Indexed: 02/04/2025] Open
Affiliation(s)
- Imran Niazi
- Aurora St. Lukes Medical Center, Advocate Health, Milwaukee, WI, USA
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Katta MR, Abouzid MRA, Hameed M, Kaur J, Balasubramanian S. Approach to Left Bundle Branch Pacing. Cardiol Rev 2025; 33:9-14. [PMID: 36912509 DOI: 10.1097/crd.0000000000000545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Cardiac pacing refers to the implantation tool serving as a treatment modality for various indications, the most common of which is symptomatic bradyarrhythmia. Left bundle branch pacing has been noted in the literature to be safer than biventricular pacing or His-bundle pacing in patients with left bundle branch block (LBBB) and heart failure, thereby becoming the focus of further research on cardiac pacing. A review of the literature was conducted using a combination of keywords, including "Left Bundle Branch Block," "Procedural techniques," "Left Bundle Capture," and "Complications." The following factors have been investigated as key criteria for direct capture: paced QRS morphology, peak left ventricular activation time, left bundle potential, nonselective and selective left bundle capture, and programmed deep septal stimulation protocol. In addition, complications of LBBP, inclusive of septal perforation, thromboembolism, right bundle branch injury, septal artery injury, lead dislodgement, lead fracture, and lead extraction, have also been elaborated on. Despite clinical implications based on clinical research comparing the use of LBBP with other forms such as right ventricular apex pacing, His-bundle pacing, biventricular pacing, and left ventricular septal pacing, a paucity in the literature on long-term effects and efficacy has been noted. LBBP can thus be considered to have a promising future in patients requiring cardiac pacing, assuming that additional research on clinical outcomes and the limitation of significant complications such as thromboembolism can be established.
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Affiliation(s)
| | | | - Maha Hameed
- Clinical Research Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Joza J, Burri H, Andrade JG, Linz D, Ellenbogen KA, Vernooy K. Atrioventricular node ablation for atrial fibrillation in the era of conduction system pacing. Eur Heart J 2024; 45:4887-4901. [PMID: 39397777 PMCID: PMC11631063 DOI: 10.1093/eurheartj/ehae656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/30/2024] [Accepted: 09/15/2024] [Indexed: 10/15/2024] Open
Abstract
Despite key advances in catheter-based treatments, the management of persistent atrial fibrillation (AF) remains a therapeutic challenge in a significant subset of patients. While success rates have improved with repeat AF ablation procedures and the concurrent use of antiarrhythmic drugs, the likelihood of maintaining sinus rhythm during long-term follow-up is still limited. Atrioventricular node ablation (AVNA) has returned as a valuable treatment option given the recent developments in cardiac pacing. With the advent of conduction system pacing, AVNA has seen a revival where pacing-induced cardiomyopathy after AVNA is felt to be overcome. This review will discuss the role of permanent pacemaker implantation and AVNA for AF management in this new era of conduction system pacing. Specifically, this review will discuss the haemodynamic consequences of AF and the mechanisms through which 'pace-and-ablate therapy' enhances outcomes, analyse historical and more recent literature across various pacing methods, and work to identify patient groups that may benefit from earlier implementation of this approach.
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Affiliation(s)
- Jacqueline Joza
- Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Haran Burri
- Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Dominik Linz
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
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6
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Rijks JHJ, Heckman L, Westra S, Cornelussen R, Ghosh S, Curila K, Smisek R, Grieco D, Bressi E, Nguyên UC, Lumens J, van Stipdonk AMW, Linz D, Prinzen FW, Luermans JGLM, Vernooy K. Assessment of ventricular electrical heterogeneity in left bundle branch pacing and left ventricular septal pacing by using various electrophysiological methods. J Cardiovasc Electrophysiol 2024; 35:2282-2292. [PMID: 39313856 DOI: 10.1111/jce.16435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 08/13/2024] [Accepted: 09/08/2024] [Indexed: 09/25/2024]
Abstract
INTRODUCTION Left bundle branch area pacing (LBBAP) comprises pacing at the left ventricular septum (LVSP) or left bundle branch (LBBP). The aim of the present study was to investigate the differences in ventricular electrical heterogeneity between LVSP, LBBP, right ventricular pacing (RVP) and intrinsic conduction with different dyssynchrony measures using the ECG, vectorcardiograpy, ECG belt, and Ultrahigh frequency (UHF-)ECG. METHODS Thirty-seven patients with a pacemaker indication for bradycardia or cardiac resynchronization therapy underwent LBBAP implantation. ECG, vectorcardiogram, ECG belt and UHF-ECG signals were recorded during RVP, LVSP and LBBP, and intrinsic activation. QRS duration (QRSd) was measured from the ECG, QRS area was calculated from the vectorcardiogram, LV activation time (LVAT) and standard deviation of activation time (SDAT) from ECG belt and electrical dyssynchrony (e-DYS16) from UHF-ECG. RESULTS Both LVSP and LBBP significantly reduced ventricular electrical heterogeneity as compared to underlying LBBB and RV pacing in terms of QRS area (p < .001), SDAT (p < .001), LVAT (p < .001) and e-DYS16 (p < .001). QRSd was only reduced as compared to RV pacing(p < .001). QRS area was similar during LBBP and normal intrinsic conduction, e-DYS16 was similar during LVSP and normal intrinsic conduction, whereas SDAT was similar for LVSP, LBBP and normal intrinsic conduction. For all these variables there was no significant difference between LVSP and LBBP. CONCLUSION Both LVSP and LBBP resulted in a more synchronous LV activation than LBBB and RVP. Especially LBBP resulted in levels of LV synchrony comparable to normal intrinsic conduction.
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Affiliation(s)
- Jesse H J Rijks
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Luuk Heckman
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Sjoerd Westra
- Department of Cardiology, Radboud University Medical Center (RadboudUMC), Nijmegen, The Netherlands
| | | | - Subham Ghosh
- Medtronic, Fridley, Minnesota, United States of America
| | - Karol Curila
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Pregue, Czechia
| | - Radovan Smisek
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czechia
| | - Domenico Grieco
- Department of Cardiology, Policlinico Casilino of Rome, Rome, Italy
| | - Edoardo Bressi
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
- Department of Cardiology, Policlinico Casilino of Rome, Rome, Italy
| | - Uyên Châu Nguyên
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Antonius M W van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Dominik Linz
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
- Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Justin G L M Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
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Kiełbasa G, Jastrzębski M, Bednarek A, Kusiak A, Sondej T, Bednarski A, Ostrowska A, Żydzik Ł, Rajzer M, Vijayaraman P, Moskal P. Strength-duration curves for left bundle branch area pacing. Heart Rhythm 2024; 21:2262-2269. [PMID: 38759916 DOI: 10.1016/j.hrthm.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/10/2024] [Accepted: 05/11/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Despite growing clinical use of left bundle branch pacing (LBBP), data regarding the fundamentals of this pacing modality, including chronaxie and rheobase, are scarce. OBJECTIVE The purpose of this study was to calculate strength-duration curves with chronaxie and rheobase values for LBBP and left ventricular septal pacing (LVSP), and to analyze battery current drain and presence of selective LBBP at very short pulse duration (PD). METHODS A group of 141 patients with permanent LBBP were studied. LBBP and LVSP capture thresholds were assessed at 6 different PDs to calculate the strength-duration curves. Battery current drain at these PDs and presence of selective LBBP were determined. For comparison of strength-duration curves between His-bundle pacing (HBP) and LBBP, source data from our previous work based on 127 patients with HBP were obtained. RESULTS The chronaxies for LBBP and LVSP were very similar (0.38 vs 0.39 ms), and the rheobases were identical (0.27 V). The chronaxie for LBBP was lower than for HBP (0.38 vs 0.53 ms; P <.001), whereas rheobases were similar (0.27 vs 0.26 V). A narrow zone of selective capture was present in 19% and 41% of patients at PD of 0.06 and 0.03 ms, respectively. When pacing with the safety margin of +1 V, the lowest battery current drain was achieved with PD of 0.2 ms. CONCLUSION The obtained strength-duration curves for LBBP and LVSP provide insights to optimal programming of left bundle branch area pacing devices with regard to PD, voltage amplitude, battery longevity, and selective capture.
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Affiliation(s)
- Grzegorz Kiełbasa
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland; First Department of Cardiology, Interventional Electrocardiology and Hypertension University Hospital in Krakow, Krakow, Poland.
| | - Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland; Electrophysiology Laboratory, University Hospital in Krakow, Krakow, Poland
| | - Agnieszka Bednarek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland; First Department of Cardiology, Interventional Electrocardiology and Hypertension University Hospital in Krakow, Krakow, Poland
| | - Aleksander Kusiak
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Tomasz Sondej
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Adam Bednarski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Aleksandra Ostrowska
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Łukasz Żydzik
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland; First Department of Cardiology, Interventional Electrocardiology and Hypertension University Hospital in Krakow, Krakow, Poland
| | - Pugazhendhi Vijayaraman
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland; Geisinger Heart Institute, Wilkes-Barre, Pennsylvania
| | - Paweł Moskal
- Electrophysiology Laboratory, University Hospital in Krakow, Krakow, Poland
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8
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Ellenbogen KA, Fagan DH, Zimmerman P, Vijayaraman P. Left bundle branch area pacing using a lumenless lead: A systematic literature review and meta-analysis. J Cardiovasc Electrophysiol 2024; 35:1721-1735. [PMID: 38664898 DOI: 10.1111/jce.16287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/20/2024] [Accepted: 04/15/2024] [Indexed: 11/20/2024]
Abstract
BACKGROUND Although left bundle branch area pacing (LBBAP) has been shown to be a feasible option for delivering physiological pacing, data are largely limited to single-center reports. The aim of this analysis was to systematically assess the safety and efficacy of LBBAP with the Model 3830 lead among primarily bradycardia patients. METHODS AND RESULTS PubMed, Embase, Cochrane Library, and Google Scholar were searched for full-text articles on LBBAP using the SelectSecure Model 3830 lumenless lead. Rates and means were estimated using random- and mixed-effects models. Of 3395 articles, 53 met inclusion criteria, representing 6061 patients undergoing an implant attempt. Average patient age was 68.1 years (95% CI: 66.6, 69.6) and 53.1% were male (95% CI: 50.5%, 55.7%). The average implant success rate among bradycardia-indicated patients was 92.7% (95% CI: 89.5%, 94.9%). The overall estimated procedural adverse event rate was 2.5% (95% CI: 1.1%, 5.4%). The estimated septal perforation rate at implant was 1.6% (95% CI: 1.0%, 2.6%) with no adverse clinical sequelae reported. Pacing thresholds were low at implant (0.67 V [95% CI: 0.64, 0.70]) and remained stable through 12 months (0.76 V [95% CI: 0.72, 0.80]). Among bradycardia-indicated patients, LVEF remained stable from baseline to post-implant (59.5% [95% CI: 57.9%, 61.1%] vs. 60.1% [95% CI: 58.5%, 61.7%]). CONCLUSION This meta-analysis including 6061 patients implanted with a Model 3830 lead for LBBAP found an average implant success rate of 92.7% and a procedural adverse event rate of 2.5% with stable electrical parameters and LVEF post-implant.
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Affiliation(s)
- Kenneth A Ellenbogen
- Department of Cardiac Electrophysiology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
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9
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Parlavecchio A, Vetta G, Coluccia G, Pistelli L, Caminiti R, Crea P, Ajello M, Magnocavallo M, Dattilo G, Foti R, Carerj S, Chierchia GB, de Asmundis C, Della Rocca DG, Palmisano P. Success and complication rates of conduction system pacing: a meta-analytical observational comparison of left bundle branch area pacing and His bundle pacing. J Interv Card Electrophysiol 2024; 67:719-729. [PMID: 37642801 DOI: 10.1007/s10840-023-01626-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) and His bundle pacing (HBP) are the main strategies to achieve conduction system pacing (CSP), but only observational studies with few patients have compared the two pacing strategies, sometimes with unclear results given the different definitions of the feasibility and safety outcomes. Therefore, we conducted a meta-analysis aiming to compare the success and complications of LBBAP versus HBP. METHODS We systematically searched the electronic databases for studies published from inception to March 22, 2023, and focusing on LBBAP versus HBP. The study endpoints were CSP success rate, device-related complications, CSP lead-related complications and non-CSP lead-related complications. RESULTS Fifteen observational studies enrolling 2491 patients met the inclusion criteria. LBBAP led to a significant increase in procedural success [91.1% vs 80.9%; RR: 1.15 (95% CI: 1.08-1.22); p < 0.00001] with a significantly lower complication rate [1.8% vs 5.2%; RR: 0.48 (95% CI: 0.29-0.78); p = 0.003], lead-related complications [1.1% vs 4.3%; RR: 0.38 (95% CI: 0.21-0.72); p = 0.003] and lead failure/deactivation [0.2% vs 3.9%; RR: 0.16 (95% CI: 0.07-0.35); p < 0.00001] than HBP. No significant differences were found between CSP lead dislodgement and non-CSP lead-related complications. CONCLUSION This meta-analysis of observational studies showed a higher success rate of LBBAP compared to HBP with a lower incidence of complications.
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Affiliation(s)
- Antonio Parlavecchio
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, 98124, Messina, Italy.
| | - Giampaolo Vetta
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, 98124, Messina, Italy
| | - Giovanni Coluccia
- Cardiology Unit, "Card. G. Panico" Hospital, Via S. Pio X, 73039, Tricase, Italy
| | - Lorenzo Pistelli
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, 98124, Messina, Italy
| | - Rodolfo Caminiti
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, 98124, Messina, Italy
| | - Pasquale Crea
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, 98124, Messina, Italy
| | - Manuela Ajello
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, 98124, Messina, Italy
| | - Michele Magnocavallo
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy
| | - Giuseppe Dattilo
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, 98124, Messina, Italy
| | | | - Scipione Carerj
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, 98124, Messina, Italy
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Pietro Palmisano
- Cardiology Unit, "Card. G. Panico" Hospital, Via S. Pio X, 73039, Tricase, Italy
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10
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Batta A, Hatwal J. Left bundle branch pacing set to outshine biventricular pacing for cardiac resynchronization therapy? World J Cardiol 2024; 16:186-190. [PMID: 38690215 PMCID: PMC11056871 DOI: 10.4330/wjc.v16.i4.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/09/2024] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
The deleterious effects of long-term right ventricular pacing necessitated the search for alternative pacing sites which could prevent or alleviate pacing-induced cardiomyopathy. Until recently, biventricular pacing (BiVP) was the only modality which could mitigate or prevent pacing induced dysfunction. Further, BiVP could resynchronize the baseline electromechanical dssynchrony in heart failure and improve outcomes. However, the high non-response rate of around 20%-30% remains a major limitation. This non-response has been largely attributable to the direct non-physiological stimulation of the left ventricular myocardium bypassing the conduction system. To overcome this limitation, the concept of conduction system pacing (CSP) came up. Despite initial success of the first CSP via His bundle pacing (HBP), certain drawbacks including lead instability and dislodgements, steep learning curve and rapid battery depletion on many occasions prevented its widespread use for cardiac resynchronization therapy (CRT). Subsequently, CSP via left bundle branch-area pacing (LBBP) was developed in 2018, which over the last few years has shown efficacy comparable to BiVP-CRT in small observational studies. Further, its safety has also been well established and is largely free of the pitfalls of the HBP-CRT. In the recent metanalysis by Yasmin et al, comprising of 6 studies with 389 participants, LBBP-CRT was superior to BiVP-CRT in terms of QRS duration, left ventricular ejection fraction, cardiac chamber dimensions, lead thresholds, and functional status amongst heart failure patients with left bundle branch block. However, there are important limitations of the study including the small overall numbers, inclusion of only a single small randomized controlled trial (RCT) and a small follow-up duration. Further, the entire study population analyzed was from China which makes generalizability a concern. Despite the concerns, the meta-analysis adds to the growing body of evidence demonstrating the efficacy of LBBP-CRT. At this stage, one must acknowledge that the fact that still our opinions on this technique are largely based on observational data and there is a dire need for larger RCTs to ascertain the position of LBBP-CRT in management of heart failure patients with left bundle branch block.
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Affiliation(s)
- Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, India.
| | - Juniali Hatwal
- Department of Internal Medicine, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
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11
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Chen J, Ezzeddine FM, Liu X, Vaidya V, McLeod CJ, Valverde AM, Del-Carpio Munoz F, Deshmukh AJ, Madhavan M, Killu AM, Mulpuru SK, Friedman PA, Cha YM. Left bundle branch pacing vs ventricular septal pacing for cardiac resynchronization therapy. Heart Rhythm O2 2024; 5:150-157. [PMID: 38560374 PMCID: PMC10980924 DOI: 10.1016/j.hroo.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background The outcomes of left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) in patients with heart failure remain to be learned. Objective The objective of this study was to assess the echocardiographic and clinical outcomes of LBBP, LVSP, and deep septal pacing (DSP). Methods This retrospective study included patients who met the criteria for cardiac resynchronization therapy (CRT) and underwent attempted LBBP in 5 Mayo centers. Clinical, electrocardiographic, and echocardiographic data were collected at baseline and follow-up. Results A total of 91 consecutive patients were included in the study. A total of 52 patients had LBBP, 25 had LVSP, and 14 had DSP. The median follow-up duration was 307 (interquartile range 208, 508) days. There was significant left ventricular ejection fraction (LVEF) improvement in the LBBP and LVSP groups (from 35.9 ± 8.5% to 46.9 ± 10.0%, P < .001 in the LBBP group; from 33.1 ± 7.5% to 41.8 ± 10.8%, P < .001 in the LVSP group) but not in the DSP group. A unipolar paced right bundle branch block morphology during the procedure in lead V1 was associated with higher odds of CRT response. There was no significant difference in heart failure hospitalization and all-cause deaths between the LBBP and LVSP groups. The rate of heart failure hospitalization and all-cause deaths were increased in the DSP group compared with the LBBP group (hazard ratio 5.10, 95% confidence interval 1.14-22.78, P = .033; and hazard ratio 7.83, 95% confidence interval 1.38-44.32, P = .020, respectively). Conclusion In patients undergoing CRT, LVSP had comparable CRT outcomes compared with LBBP.
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Affiliation(s)
- Jingjing Chen
- Department of Cardiovascular Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Xiaoke Liu
- Department of Cardiovascular Medicine, Mayo Clinic, La Crosse, Wisconsin
| | - Vaibhav Vaidya
- Department of Cardiovascular Medicine, Mayo Clinic, Eau Claire, Wisconsin
| | | | | | | | | | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ammar M. Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Siva K. Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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12
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Eerenberg F, Luermans J, Lumens J, Nguyên UC, Vernooy K, van Stipdonk A. Exploring QRS Area beyond Patient Selection in CRT-Can It Guide Left Ventricular Lead Placement? J Cardiovasc Dev Dis 2024; 11:18. [PMID: 38248888 PMCID: PMC10816025 DOI: 10.3390/jcdd11010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Vectorcardiographic QRS area is a promising tool for patient selection and implantation guidance in cardiac resynchronization therapy (CRT). Research has mainly focused on the role of QRS area in patient selection for CRT. Recently, QRS area has been proposed as a tool to guide left ventricular lead placement in CRT. Theoretically, vector-based electrical information of ventricular fusion pacing, calculated from the basic 12-lead ECG, can give real-time insight into the extent of resynchronization at any LV lead position, as well as any selected electrode on the LV lead. The objective of this review is to provide an overview of the background of vectorcardiographic QRS area and its potential in optimizing LV lead location in order to optimize the benefits of CRT.
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Affiliation(s)
- Frederieke Eerenberg
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, 6229 ER Maastricht, The Netherlands; (J.L.); (U.C.N.); (K.V.); (A.v.S.)
| | - Justin Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, 6229 ER Maastricht, The Netherlands; (J.L.); (U.C.N.); (K.V.); (A.v.S.)
| | - Joost Lumens
- Cardiovascular Research Institute Maastricht (CARIM), University Maastricht (UM), 6229 ER Maastricht, The Netherlands;
| | - Uyên Châu Nguyên
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, 6229 ER Maastricht, The Netherlands; (J.L.); (U.C.N.); (K.V.); (A.v.S.)
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, 6229 ER Maastricht, The Netherlands; (J.L.); (U.C.N.); (K.V.); (A.v.S.)
| | - Antonius van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, 6229 ER Maastricht, The Netherlands; (J.L.); (U.C.N.); (K.V.); (A.v.S.)
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13
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Yang Z, Liang J, Chen R, Pang N, Zhang N, Guo M, Gao J, Wang R. Clinical outcomes of left bundle branch area pacing: Prognosis and specific applications. Pacing Clin Electrophysiol 2024; 47:80-87. [PMID: 38112026 DOI: 10.1111/pace.14907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/02/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023]
Abstract
Cardiac pacing has become a widely accepted treatment strategy for bradyarrhythmia and heart failure. However, conventional right ventricular pacing (RVP) has been associated with electrical dyssynchrony, which may result in atrial fibrillation and heart failure. To achieve physiological pacing, Deshmukh et al. reported the first case of His bundle pacing (HBP) in 2000. This strategy was reported to have preserved ventricular synchronization by activating the conventional conduction system. Nonetheless, due to the anatomical location of the His bundle (HB), several issues such as high pacing thresholds, lead fixation, and early battery depletion may pose a challenge. Recently, left bundle branch area pacing (LBBAP) has emerged as a novel physiological pacing strategy to achieve conduction system pacing by capturing the left bundle branch through the deep septum. Additionally, several studies have investigated the clinical outcomes of LBBAP. In this paper, we describe the pacing parameters, QRS duration (QRSd), cardiac function, complications, and specific applications of LBBAP in recent years.
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Affiliation(s)
- Zhen Yang
- The First Clinical Medical College, Shanxi Medical University, Shanxi, China
- Department of Cardiology, First Hospital of Shanxi Medical University, Shanxi, China
| | - Jiadong Liang
- The First Clinical Medical College, Shanxi Medical University, Shanxi, China
- Department of Cardiology, First Hospital of Shanxi Medical University, Shanxi, China
| | - Ruizhe Chen
- The First Clinical Medical College, Shanxi Medical University, Shanxi, China
- Department of Cardiology, First Hospital of Shanxi Medical University, Shanxi, China
| | - Naidong Pang
- The First Clinical Medical College, Shanxi Medical University, Shanxi, China
- Department of Cardiology, First Hospital of Shanxi Medical University, Shanxi, China
| | - Nan Zhang
- Department of Cardiology, First Hospital of Shanxi Medical University, Shanxi, China
| | - Min Guo
- Department of Cardiology, First Hospital of Shanxi Medical University, Shanxi, China
| | - Jia Gao
- Department of Cardiology, First Hospital of Shanxi Medical University, Shanxi, China
| | - Rui Wang
- Department of Cardiology, First Hospital of Shanxi Medical University, Shanxi, China
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14
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Diaz JC, Duque M, Aristizabal J, Marin J, Niño C, Bastidas O, Ruiz LM, Matos CD, Hoyos C, Hincapie D, Velasco A, Romero JE. The Emerging Role of Left Bundle Branch Area Pacing for Cardiac Resynchronisation Therapy. Arrhythm Electrophysiol Rev 2023; 12:e29. [PMID: 38173800 PMCID: PMC10762674 DOI: 10.15420/aer.2023.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/04/2023] [Indexed: 01/05/2024] Open
Abstract
Cardiac resynchronisation therapy (CRT) reduces the risk of heart failure-related hospitalisations and all-cause mortality, as well as improving quality of life and functional status in patients with persistent heart failure symptoms despite optimal medical treatment and left bundle branch block. CRT has traditionally been delivered by implanting a lead through the coronary sinus to capture the left ventricular epicardium; however, this approach is associated with significant drawbacks, including a high rate of procedural failure, phrenic nerve stimulation, high pacing thresholds and lead dislodgement. Moreover, a significant proportion of patients fail to derive any significant benefit. Left bundle branch area pacing (LBBAP) has recently emerged as a suitable alternative to traditional CRT. By stimulating the cardiac conduction system physiologically, LBBAP can result in a more homogeneous left ventricular contraction and relaxation, thus having the potential to improve outcomes compared with conventional CRT strategies. In this article, the evidence supporting the use of LBBAP in patients with heart failure is reviewed.
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Affiliation(s)
- Juan Carlos Diaz
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical SchoolMedellin, Colombia
| | - Mauricio Duque
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical SchoolMedellin, Colombia
| | - Julian Aristizabal
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las AmericasMedellin, Colombia
| | - Jorge Marin
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las AmericasMedellin, Colombia
| | - Cesar Niño
- Cardiac Arrhythmia and Electrophysiology Service, Hospital Pablo Tobón UribeMedellin, Colombia
| | - Oriana Bastidas
- Cardiac Arrhythmia and Electrophysiology Service, Hospital Pablo Tobón UribeMedellin, Colombia
| | | | - Carlos D Matos
- Cardiac Arrhythmia Service, Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, US
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, US
| | - Daniela Hincapie
- Cardiac Arrhythmia Service, Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, US
| | - Alejandro Velasco
- Electrophysiology Section, University of Texas Health Sciences CentreSan Antonio, TX, US
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, US
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15
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Leventopoulos G, Travlos CK, Aronis KN, Anagnostopoulou V, Patrinos P, Papageorgiou A, Perperis A, Gale CP, Davlouros P. Safety and efficacy of left bundle branch area pacing compared with right ventricular pacing in patients with bradyarrhythmia and conduction system disorders: Systematic review and meta-analysis. Int J Cardiol 2023; 390:131230. [PMID: 37527751 DOI: 10.1016/j.ijcard.2023.131230] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/03/2023] [Accepted: 07/28/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Right Ventricular Pacing (RVP) may have detrimental effects in ventricular function. Left Bundle Branch Area Pacing (LBBAP) is a new pacing strategy that appears to have better results. The aim of this systematic review and meta-analysis is to compare the safety and efficacy of LBBAP vs RVP in patients with bradyarrhythmia and conduction system disorders. METHODS MEDLINE, EMBASE and Pubmed databases were searched for studies comparing LBBAP with RVP. Outcomes were all-cause mortality, atrial fibrillation (AF) occurrence, heart failure hospitalizations (HFH) and complications. QRS duration, mechanical synchrony and LVEF changes were also assessed. Pairwise meta-analysis was conducted using random and fixed effects models. RESULTS Twenty-five trials with 4250 patients (2127 LBBAP) were included in the analysis. LBBAP was associated with lower risk for HFH (RR:0.33, CI 95%:0.21 to 0.50; p < 0.001), all-cause mortality (RR:0.52 CI 95%:0.34 to 0.80; p = 0.003), and AF occurrence (RR:0.43 CI 95%:0.27 to 0.68; p < 0.001) than RVP. Lead related complications were not different between the two groups (p = 0.780). QRSd was shorter in the LBBAP group at follow-up (WMD: -32.20 msec, CI 95%: -40.70 to -23.71; p < 0.001) and LBBAP achieved better intraventricular mechanical synchrony than RVP (SMD: -1.77, CI 95%: -2.45 to -1.09; p < 0.001). LBBAP had similar pacing thresholds (p = 0.860) and higher R wave amplitudes (p = 0.009) than RVP. CONCLUSIONS LBBAP has better clinical outcomes, preserves ventricular electrical and mechanical synchrony and has excellent pacing parameters, with no difference in complications compared to RVP.
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Affiliation(s)
| | - Christoforos K Travlos
- Department of Cardiology, University Hospital of Patras, Rio, Patras, Greece; Department of Medicine, University of Patras, Patras, Greece
| | - Konstantinos N Aronis
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Virginia Anagnostopoulou
- Department of Cardiology, University Hospital of Patras, Rio, Patras, Greece; Department of Medicine, University of Patras, Patras, Greece
| | - Panagiotis Patrinos
- Department of Cardiology, University Hospital of Patras, Rio, Patras, Greece
| | | | - Angelos Perperis
- Department of Cardiology, University Hospital of Patras, Rio, Patras, Greece
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Periklis Davlouros
- Department of Cardiology, University Hospital of Patras, Rio, Patras, Greece
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16
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Vernooy K, Keene D, Huang W, Vijayaraman P. Implant, assessment, and management of conduction system pacing. Eur Heart J Suppl 2023; 25:G15-G26. [PMID: 37970519 PMCID: PMC10637838 DOI: 10.1093/eurheartjsupp/suad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
His bundle pacing and left bundle branch pacing, together referred to as conduction system pacing, have (re)gained considerable interest over the past years as it has the potential to preserve and/or restore a more physiological ventricular activation when compared with right ventricular pacing and may serve as an alternative for cardiac resynchronization therapy. This review manuscript dives deeper into the implantation techniques and the relevant anatomy of the conduction system for both pacing strategies. Furthermore, the manuscript elaborates on better understanding of conduction system capture with its various capture patterns, its potential complications as well as appropriate follow-up care. Finally, the limitations and its impact on clinical care for both His bundle pacing and left bundle branch pacing are being discussed.
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Affiliation(s)
- Kevin Vernooy
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, UK
| | - Weijian Huang
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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17
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Curila K, Burri H. Left ventricular septal pacing - can we trust the ECG? Indian Pacing Electrophysiol J 2023; 23:155-157. [PMID: 37429526 PMCID: PMC10491966 DOI: 10.1016/j.ipej.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/28/2023] [Accepted: 07/07/2023] [Indexed: 07/12/2023] Open
Abstract
In contrast to left bundle branch pacing, the criteria for left ventricular septal pacing (LVSP) were never validated. LVSP is usually defined as deep septal deployment of the pacing lead with a pseudo-right bundle branch morphology in V1. The case report describes an implant procedure during which this definition of LVSP was fulfilled in four of five pacing locations within the septum, with the shallowest of them present in less than 50% of the septal thickness. The case highlights the need for a more precise definition of LVSP.
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Affiliation(s)
- Karol Curila
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
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18
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Marcantoni L, Pastore G, Biffi M, Zanon F. The weakest point of cardiac resynchronization therapy: new technologies facing old terminology. Front Cardiovasc Med 2023; 10:1236369. [PMID: 37636299 PMCID: PMC10450245 DOI: 10.3389/fcvm.2023.1236369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Patients with symptomatic heart failure (HF) and left bundle branch block (LBBB) are currently treated with biventricular pacing (BiV) which has a Class IA recommendation. Given the possibility to re-establish the inter and intra-ventricular synchrony, BiV is commonly referred to as cardiac resynchronization therapy (CRT). This wording is widely utilized and over time the terms BiV and CRT have become interchangeable. Conduction system pacing (CSP) is emerging as a valid therapeutic opportunity to obtain CRT restoring the native conduction via the Purkinje network. Therefore the acronym CRT is no longer synonymous with BiV only but could also refer to CSP. A terminology update is needed to include the resource of CSP to ensure better communication among all the stakeholders involved in managing recipients of cardiac devices and should be a fundamental step in advancing the quality of patient care. Making use of the NBG code to describe the implantable cardiac device would ease such terminology update, since only the first three positions of the five letters NBG code are commonly utilized, while the last two are rarely used.
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Affiliation(s)
- Lina Marcantoni
- Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Gianni Pastore
- Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Mauro Biffi
- Istituto di Cardiologia, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy
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19
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Briongos-Figuero S, Estévez Paniagua Á, Sánchez Hernández A, Muñoz-Aguilera R. Redefining QRS transition to confirm left bundle branch capture during left bundle branch area pacing. Front Cardiovasc Med 2023; 10:1217133. [PMID: 37522077 PMCID: PMC10375013 DOI: 10.3389/fcvm.2023.1217133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023] Open
Abstract
Background QRS transition criteria during dynamic manoeuvers are the gold-standard for non-invasive confirmation of left bundle branch (LBB) capture, but they are seen in <50% of LBB area pacing (LBBAP) procedures. Objective We hypothesized that transition from left ventricular septal pacing (LVSP) to LBB pacing (LBBP), when observed during lead penetration into the deep interventricular septum (IVS) with interrupted pacemapping, can suggest LBB capture. Methods QRS transition during lead screwing-in was defined as shortening of paced V6-R wave peak time (RWPT) by ≥10 ms from LVSP to non-selective LBBP (ns-LBBP) obtained during mid to deep septal lead progression at the same target area, between two consecutive pacing manoeuvres. ECG-based criteria were used to compared LVSP and ns-LBBP morphologies obtained by interrupted pacemapping. Results Sixty patients with demonstrated transition from LVSP to ns-LBBP during dynamic manoeuvers were compared to 44 patients with the same transition during lead screwing-in. Average shortening in paced V6-RWPT was similar among study groups (17.3 ± 6.8 ms vs. 18.8 ± 4.9 ms for transition during dynamic manoeuvres and lead screwing-in, respectively; p = 0.719). Paced V6-RWPT and aVL-RWPT, V6-V1 interpeak interval and the recently described LBBP score, were also similar for ns-LBBP morphologies in both groups. LVSP morphologies showed longer V6-RWPT and aVL-RWPT, shorter V6-V1 interpeak interval and lower LBBP score punctuation, without differences among the two QRS transition groups. V6-RWPT < 75 ms or V6-V1 interpeak interval > 44 ms criterion was more frequently achieved in ns-LBBP morphologies obtained during lead screwing-in compared to those obtained during dynamic manoeuvres (70.5% vs. 50%, respectively p = 0.036). Conclusions During LBBAP procedure, QRS transition from LVSP to ns-LBBP can be observed as the lead penetrates deep into the IVS with interrupted pacemapping. Shortening of at least 10 ms in paced V6-RWPT may serve as marker of LBB capture.
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20
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Rijks JHJ, Lankveld T, Manusama R, Broers B, Stipdonk AMWV, Chaldoupi SM, Bekke RMAT, Schotten U, Linz D, Luermans JGLM, Vernooy K. Left Bundle Branch Area Pacing and Atrioventricular Node Ablation in a Single-Procedure Approach for Elderly Patients with Symptomatic Atrial Fibrillation. J Clin Med 2023; 12:4028. [PMID: 37373721 DOI: 10.3390/jcm12124028] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Implantation of a permanent pacemaker and atrioventricular (AV) node ablation (pace-and-ablate) is an established approach for rate and symptom control in elderly patients with symptomatic atrial fibrillation (AF). Left bundle branch area pacing (LBBAP) is a physiological pacing strategy that might overcome right ventricular pacing-induced dyssynchrony. In this study, the feasibility and safety of performing LBBAP and AV node ablation in a single procedure in the elderly was investigated. METHODS Consecutive patients with symptomatic AF referred for pace-and-ablate underwent the treatment in a single procedure. Data on procedure-related complications and lead stability were collected at regular follow-up at one day, ten days and six weeks after the procedure and continued every six months thereafter. RESULTS 25 patients (mean age 79.2 ± 4.2 years) were included and underwent successful LBBAP. In 22 (88%) patients, AV node ablation and LBBAP were performed in the same procedure. AV node ablation was postponed in two patients due to lead-stability concerns and in one patient on their own request. No complications related to the single-procedure approach were observed with no lead-stability issues at follow-up. CONCLUSIONS LBBAP combined with AV node ablation in a single procedure is feasible and safe in elderly patients with symptomatic AF.
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Affiliation(s)
- Jesse H J Rijks
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Theo Lankveld
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
- Department of Cardiology, Zuyderland Medical Centre, 6419 PC Heerlen, The Netherlands
| | - Randolph Manusama
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
- Department of Cardiology, Zuyderland Medical Centre, 6419 PC Heerlen, The Netherlands
| | - Bernard Broers
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
- Department of Cardiology, Zuyderland Medical Centre, 6419 PC Heerlen, The Netherlands
| | - Antonius M W van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Sevasti Maria Chaldoupi
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Rachel M A Ter Bekke
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Ulrich Schotten
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Dominik Linz
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
- Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA 5005, Australia
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1172 Copenhagen, Denmark
| | - Justin G L M Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
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21
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Pastore G, Bertini M, Bonanno C, Coluccia G, Dell'Era G, De Mattia L, Grieco D, Katsouras G, Maines M, Marcantoni L, Marinaccio L, Paglino G, Palmisano P, Ziacchi M, Zoppo F, Noventa F. The PhysioVP-AF study, a randomized controlled trial to assess the clinical benefit of physiological ventricular pacing vs. managed ventricular pacing for persistent atrial fibrillation prevention in patients with prolonged atrioventricular conduction: design and rationale. Europace 2023; 25:euad082. [PMID: 36974970 PMCID: PMC10228539 DOI: 10.1093/europace/euad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/23/2023] [Indexed: 03/29/2023] Open
Abstract
AIMS In patients with prolonged atrioventricular (AV) conduction and pacemaker (PM) indication due to sinus node disease (SND) or intermittent AV-block who do not need continuous ventricular pacing (VP), it may be difficult to determine which strategy to adopt. Currently, the standard of care is to minimize unnecessary VP by specific VP avoidance (VPA) algorithms. The superiority of this strategy over standard DDD or DDD rate-responsive (DDD/DDDR) in improving clinical outcomes is controversial, probably owing to the prolongation of the atrialventricular conduction (PR interval) caused by the algorithms. Conduction system pacing (CSP) may offer the most physiological-VP approach, providing appropriate AV conduction and preventing pacing-induced dyssynchrony. METHODS AND RESULTS PhysioVP-AF is a prospective, controlled, randomized, single-blind trial designed to determine whether atrial-synchronized conduction system pacing (DDD-CSP) is superior to standard DDD-VPA pacing in terms of 3-year reduction of persistent-AF occurrence. Cardiovascular hospitalization, quality-of-life, and safety will be evaluated. Patients with indication for permanent DDD pacing for SND or intermittent AV-block and prolonged AV conduction (PR interval > 180 ms) will be randomized (1:1 ratio) to DDD-VPA (VPA-algorithms ON, septal/apex position) or to DDD-CSP (His bundle or left bundle branch area pacing, AV-delay setting to control PR interval, VPA-algorithms OFF). Approximately 400 patients will be randomized in 24 months in 13 Italian centres. CONCLUSION The PhysioVP-AF study will provide an essential contribution to patient management with prolonged AV conduction and PM indication for sinus nodal disease or paroxysmal 2nd-degree AV-block by determining whether CSP combined with a controlled PR interval is superior to standard management that minimizes unnecessary VP in terms of reducing clinical outcomes.
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Affiliation(s)
- Gianni Pastore
- Department of Cardiology, Santa Maria della Misericordia Hospital, Via Tre Martiri 140, 45100 Rovigo, Italy
| | - Matteo Bertini
- Department of Cardiology, University Hospital, via Aldo Moro, n 8, 44124 Ferrara, Italy
| | - Carlo Bonanno
- Department of Cardiology, San Bortolo Hospital, Viale Rodolfi 37, 36100 Vicenza, Italy
| | - Giovanni Coluccia
- Department of Cardiology, C. G. Panico Hospital, via San Pio X 4, 73039 LecceItaly
| | - Gabriele Dell'Era
- Department of Cardiology, Maggiore della Carità Hospital, corso Mazzini 18, 28100 Novara, Italy
| | - Luca De Mattia
- Department of Cardiology, Ca’ Foncello Hospital, Piazzale Ospedale 1, 31100 Treviso, Italy
| | - Domenico Grieco
- Department of Cardiology, Policlinico Casilino, via Casilina n.1049, 00169 Roma, Italy
| | - Grigorius Katsouras
- Department of Cardiology, F. Miulli Hospital, Strada Provinciale 127, 70021 Acquaviva delle Fonti, BA, Italy
| | - Massimiliano Maines
- Department of Cardiology, Santa Maria del Carmine Hospital, corso Verona 4, 38068 Rovereto, TN, Italy
| | - Lina Marcantoni
- Department of Cardiology, Santa Maria della Misericordia Hospital, Via Tre Martiri 140, 45100 Rovigo, Italy
| | - Leonardo Marinaccio
- Department of Cardiology, Immacolata Concezione Hospital, via San Rocco 8, 35028 Piove di Sacco, PD, Italy
| | - Gabriele Paglino
- Department of Cardiology, IRCCS San Raffaele Hospital, via Olgettina 60, 20132 Milano, Italy
| | - Pietro Palmisano
- Department of Cardiology, C. G. Panico Hospital, via San Pio X 4, 73039 LecceItaly
| | - Matteo Ziacchi
- Department of Cardiology, IRCCS Az. Osp. Università Bologna, via Massarenti 9, 40138 Bologna, Italy
| | - Franco Zoppo
- Department of Cardiology, Osp. Civile Portogruaro, via Piemonte 1, 30026 Portogruaro VE, Italy
| | - Franco Noventa
- QUOVADIS no-profit Association, Gall. Ezzelino 5, 35139 Padova, Italy
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22
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Bednarek A, Kiełbasa G, Moskal P, Ostrowska A, Bednarski A, Sondej T, Kusiak A, Rajzer M, Jastrzębski M. Left bundle branch area pacing prevents pacing induced cardiomyopathy in long-term observation. Pacing Clin Electrophysiol 2023. [PMID: 37154051 DOI: 10.1111/pace.14707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/08/2023] [Accepted: 04/15/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) is one of the methods to deliver conduction system pacing which potentially avoids the negative impact of conventional right ventricular pacing. OBJECTIVE To assess echocardiographic outcomes in a long-term observation in patients with LBBAP implemented for bradyarrhythmia indications. METHODS AND RESULTS A total of 151 patients with symptomatic bradycardia and LBBAP pacemaker implanted, were prospectively included in the study. Subjects with left bundle branch block and CRT indications (n = 29), ventricular pacing burden <40% (n = 11), and loss of LBBAP (n = 10) were excluded from further analysis. At baseline and the last follow-up visit, echocardiography with global longitudinal strain (GLS) assessment, 12-lead ECG, pacemaker interrogation, and blood level of NT-proBNP were performed. The median follow-up period was 23 months (15.5-28). None of the analyzed patients fulfilled the criteria for pacing induced cardiomyopathy (PICM). Improvement in left ventricular ejection fraction (LVEF) and GLS was observed in patients with LVEF <50% at baseline (n = 39): 41.4 ± 9.2% versus 45.6 ± 9.9%, and 12.9 ± 3.6% versus 15.5 ± 3.7%, respectively. In the subgroup with preserved EF (n = 62), LVEF and GLS remained stable at follow-up: 59.3 ± 5.5% versus 60 ± 5.5%, and 19 ± 3.9% versus 19.4 ± 3.8%, respectively. CONCLUSION LBBAP prevents PICM in patients with preserved LVEF and improves left ventricle function in subjects with depressed LVEF. LBBAP might be the preferred pacing modality for bradyarrhythmia indications.
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Affiliation(s)
- Agnieszka Bednarek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Grzegorz Kiełbasa
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Paweł Moskal
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Aleksandra Ostrowska
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Adam Bednarski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Tomasz Sondej
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Aleksander Kusiak
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
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23
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Burri H, Jastrzebski M, Cano Ó, Čurila K, de Pooter J, Huang W, Israel C, Joza J, Romero J, Vernooy K, Vijayaraman P, Whinnett Z, Zanon F. EHRA clinical consensus statement on conduction system pacing implantation: executive summary. Endorsed by the Asia-Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS) and Latin-American Heart Rhythm Society (LAHRS). Europace 2023; 25:1237-1248. [PMID: 37061850 PMCID: PMC10105857 DOI: 10.1093/europace/euad044] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 04/17/2023] Open
Abstract
Conduction system pacing (CSP) has emerged as a more physiological alternative to right ventricular pacing and is also being used in selected cases for cardiac resynchronization therapy. His bundle pacing was first introduced over two decades ago and its use has risen over the last years with the advent of tools which have facilitated implantation. Left bundle branch area pacing is more recent but its adoption is growing fast due to a wider target area and excellent electrical parameters. Nevertheless, as with any intervention, proper technique is a prerequisite for safe and effective delivery of therapy. This document aims to standardize the procedure and to provide a framework for physicians who wish to start CSP implantation, or who wish to improve their technique. A synopsis is provided in this print edition of EP-Europace. The full document may be consulted online, and a 'Key Messages' App can be downloaded from the EHRA website.
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Affiliation(s)
- Haran Burri
- Cardiac Pacing Unit, University Hospital of Geneva,
Geneva, Switzerland
| | - Marek Jastrzebski
- First Department of Cardiology and Electrocardiology and Arterial
Hypertension, Jagiellonian University, Krakow,
Poland
| | - Óscar Cano
- Hospital Universitario y Politecnico La Fe, ValenciamSpain and Centro de
Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares
(CIBERCV), Madrid, Spain
| | - Karol Čurila
- Cardiocenter, Third Faculty of Medicine, Charles University and University
Hospital, Kralovske Vinohrady, Prague, Czech Republic
| | - Jan de Pooter
- Heart Centre, University Hospital Ghent,
Ghent, Belgium
| | - Weijian Huang
- The First Affiliated Hospital of Wenzhou Medical University,
Wenzhou, China
| | | | - Jacqueline Joza
- Department of Medicine, McGill University Health Center,
Montreal, Canada
| | - Jorge Romero
- Brigham and Women's Hospital, Boston,
Massachusetts, United States of
America
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht
(CARIM), Maastricht University Medical Center,
Maastricht, The
Netherlands
| | | | - Zachary Whinnett
- National Heart and Lung institute, Imperial College London,
United Kingdom
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Santa Maria della Misericordia
General Hospital, Rovigo, Italy
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24
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Grieco D, Bressi E, Sedláček K, Čurila K, Vernooy K, Fedele E, De Ruvo E, Fagagnini A, Kron J, Padala SK, Ellenbogen KA, Calò L. Feasibility and safety of left bundle branch area pacing-cardiac resynchronization therapy in elderly patients. J Interv Card Electrophysiol 2023; 66:311-321. [PMID: 35266067 DOI: 10.1007/s10840-022-01174-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/27/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) is an emerging technique to achieve cardiac resynchronization therapy (CRT), but its feasibility and safety in elderly patients with heart failure with reduced ejection fraction and left bundle branch block is hardly investigated. METHODS We enrolled consecutive patients with an indication for CRT comparing pacing parameters and complication rates of LBBAP-CRT in elderly patients (≥ 75 years) versus younger patients (< 75 years) over a 6-month follow-up. RESULTS LBBAP was successful in 55/60 enrolled patients (92%), among which 25(45%) were elderly. In both groups, LBBAP significantly reduced the QRS duration (elderly group: 168 ± 15 ms to 136 ± 12 ms, p < 0.0001; younger group: 166 ± 14 ms to 134 ± 11 ms, p < 0.0001) and improved LVEF (elderly group: 28 ± 5% to 40 ± 7%, p < 0.0001; younger group: 29 ± 5% to 41 ± 8%, p < 0.0001). The pacing threshold was 0.9 ± 0.8 V in the elderly group vs. 0.7 ± 0.5 V in the younger group (p = 0.350). The R wave was 9.5 ± 3.9 mV in elderly patients vs. 10.7 ± 2.7 mV in younger patients (p = 0.341). The fluoroscopic (elderly: 13 ± 7 min vs. younger: 11 ± 7 min, p = 0.153) and procedural time (elderly: 80 ± 20 min vs. younger: 78 ± 16 min, p = 0.749) were comparable between groups. Lead dislodgement occurred in 2(4%) patients, 1 in each group (p = 1.000). Intraprocedural septal perforation occurred in three patients (5%), 2(8%) in the elderly group (p = 0.585). One patient (2%) in the elderly group had a pocket infection. CONCLUSIONS LBBAP is a feasible and safe technique for delivering physiological pacing in elderly patients who are candidates for CRT with suitable pacing parameters and low complication rates.
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Affiliation(s)
- Domenico Grieco
- Department of Cardiovascular Sciences, Policlinico Casilino of Rome, Via Casilina, 1049, 00169, Rome, Italy
| | - Edoardo Bressi
- Department of Cardiovascular Sciences, Policlinico Casilino of Rome, Via Casilina, 1049, 00169, Rome, Italy. .,Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands. .,Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA.
| | - Kamil Sedláček
- 1st Department of Internal Medicine - Cardiology and Angiology, Faculty of Medicine, University Hospital and Charles University, Hradec Králové, Czech Republic
| | - Karol Čurila
- Department of Cardiology, Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elisa Fedele
- Department of Cardiovascular Sciences, Policlinico Casilino of Rome, Via Casilina, 1049, 00169, Rome, Italy
| | - Ermenegildo De Ruvo
- Department of Cardiovascular Sciences, Policlinico Casilino of Rome, Via Casilina, 1049, 00169, Rome, Italy
| | - Alessandro Fagagnini
- Department of Cardiovascular Sciences, Policlinico Casilino of Rome, Via Casilina, 1049, 00169, Rome, Italy
| | - Jordana Kron
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Santosh K Padala
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Kenneth A Ellenbogen
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Leonardo Calò
- Department of Cardiovascular Sciences, Policlinico Casilino of Rome, Via Casilina, 1049, 00169, Rome, Italy
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25
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Zhang W, Chen L, Zhou X, Huang J, Zhu S, Shen E, Pan C, Hou X, Li R, He B. Resynchronization effects and clinical outcomes during left bundle branch area pacing with and without conduction system capture. Clin Cardiol 2023; 46:287-295. [PMID: 36597668 PMCID: PMC10018083 DOI: 10.1002/clc.23969] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/16/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) includes left bundle branch pacing (LBBP) and left ventricular (LV) septal myocardial pacing (LVSP). HYPOTHESIS The study aimed to assess resynchronization effects and clinical outcomes by LBBAP in heart failure (HF) patients with cardiac resynchronization therapy (CRT) indications. METHODS LBBAP was successfully performed in 29 consecutive patients and further classified as the LBBP-group (N = 15) and LVSP-group (N = 14) based on the LBBP criteria and novel LV conduction time measurement (LV CT, between LBBAP site and LV pacing (LVP) site). AV-interval optimized LBBP or LVSP, or LVSP combined with LVP (LVSP-LVP) was applied. LV electrical and mechanical synchrony and clinical outcomes were assessed. RESULTS All 15 patients in the LBBP-group received optimized LBBP while 14 patients in the LVSP-group received either optimized LVSP (5) or LVSP-LVP (9). The LV CT during LBBP was significantly faster than that during LVP (p < .001), while LV CT during LVSP were similar to LVP (p = .226). The stimulus to peak LV activation time (Stim-LVAT, 71.2 ± 8.3 ms) and LV mechanical synchrony (TSI-SD, 35.3 ± 9.5 ms) during LBBP were significantly shorter than those during LVSP (Stim-LVAT 89.1 ± 19.5 ms, TSI-SD 49.8 ± 14.4 ms, both p < .05). Following 17(IQR 8) months of follow-up, the improvement of LVEF (26.0%(IQR 16.0)) in the LBBP-group was significantly greater than that in the LVSP-group (6.0%(IQR 20.8), p = .001). CONCLUSIONS LV activation in LBBP propagated significantly faster than that of LVSP. LBBP generated superior electrical and mechanical resynchronization and better LVEF improvement over LVSP in HF patients with CRT indications.
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Affiliation(s)
- Weiwei Zhang
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lu Chen
- Department of Ultrasound, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaohong Zhou
- Cardiac Rhythm and Heart Failure Division, Medtronic plc, Mounds View, Minnesota, USA
| | - Jingjuan Huang
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shiwei Zhu
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - E Shen
- Department of Ultrasound, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Changqing Pan
- Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xumin Hou
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ruogu Li
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ben He
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Orlov MV, Nikolaychuk M, Koulouridis I, Goldman A, Natan S, Armstrong J, Bhattacharya A, Hicks A, King M, Wylie J. Left bundle area pacing: Guiding implant depth by ring measurements. Heart Rhythm 2023; 20:55-60. [PMID: 36152975 DOI: 10.1016/j.hrthm.2022.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/11/2022] [Accepted: 09/16/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Criteria for successful left bundle area pacing (LBAP) are in flux and currently guided by lead tip measurements. Lead ring measurements during LBAP have not been well studied. OBJECTIVE The purpose of this study was to investigate dynamics in pacing parameters during successful and unsuccessful lead implant attempts. METHODS SelectSecure 3830 pacing leads (Medtronic, Inc) guided by C315 sheaths for LBAP were placed for standard pacing indications in 73 patients. Retrospective review of procedural, echocardiographic, and standard pacing data were performed. Depth and lead-septal angle of implanted electrodes were determined from fluoroscopy with septal contrast delineation. Depth was graded in 4 categories according to the degree of ring penetration into the septum. Successful implant was defined by the ability to advance the lead deep into the septum and achieve LBAP criteria (ventricular activation time, QRS width/shape). RESULTS Ring impedance increased stepwise during successful attempts as opposed to unsuccessful attempts (P = .039). A wider lead-septal angle at implant position correlated with higher ring impedance (P = .036), whereas no association was found with tip impedance. Unipolar ring threshold correlated with depth of lead implant (P = .029). Tip impedance measurements at implant position were less predictive of lead depth and did not correlate with septal thickness. CONCLUSION Ring pacing parameters are more predictive of lead progress than tip measurements. Lead depth and lead-septal angle can be determined from ring impedance measurements. These measurements may provide determination of lead depth and could obviate the need for contrast injection.
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Affiliation(s)
- Michael V Orlov
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center/Tufts University School of Medicine, Boston, Massachusetts.
| | - Marianna Nikolaychuk
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center/Tufts University School of Medicine, Boston, Massachusetts
| | - Ioannis Koulouridis
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center/Tufts University School of Medicine, Boston, Massachusetts
| | - Alena Goldman
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center/Tufts University School of Medicine, Boston, Massachusetts
| | - Shaw Natan
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center/Tufts University School of Medicine, Boston, Massachusetts
| | - James Armstrong
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center/Tufts University School of Medicine, Boston, Massachusetts
| | - Adhiraj Bhattacharya
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center/Tufts University School of Medicine, Boston, Massachusetts
| | - Amy Hicks
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center/Tufts University School of Medicine, Boston, Massachusetts
| | - Michael King
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center/Tufts University School of Medicine, Boston, Massachusetts
| | - John Wylie
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center/Tufts University School of Medicine, Boston, Massachusetts
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27
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Shen J, Jiang L, Wu H, Cai X, Zhuo S, Pan L. A Continuous Pacing and Recording Technique for Differentiating Left Bundle Branch Pacing From Left Ventricular Septal Pacing: Electrophysiologic Evidence From an Intrapatient-Controlled Study. Can J Cardiol 2023; 39:1-10. [PMID: 36113707 DOI: 10.1016/j.cjca.2022.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Left bundle branch pacing (LBBP) is a promising approach for achieving near-physiologic pacing. However, differentiating LBBP from left ventricular septal endocardial pacing (LVS(e)P) remains a challenge. This study aimed to establish a simple and effective method for differentiating LBBP from LVS(e)P and to evaluate their electrophysiologic characteristics. METHODS LBBP, using continuous uninterrupted pacing and real-time monitoring of electrocardiograms along with intracardiac electrograms, was performed in 97 consecutive patients. We evaluated the electrophysiologic characteristics observed during LBBP using 6 modalities: right ventricular septal pacing (RVSP), intraventricular septal pacing (IVSP 1 and 2), LVS(e)P, nonselective LBBP (NSLBBP), and selective LBBP (SLBBP). RESULTS Of the 97 patients, 87 (89.7%) met the criteria (abrupt change in paced QRS morphology with a transition from Qr to QR/qR in lead V1 and shortening of stimulus to V6 R-wave peak time [Stim-V6RWPT] of ≥ 10 ms with constant output while rather than after lead screwing) for nonselective left bundle branch (LBB) capture. Selective LBB capture was observed in 82 patients (84.5%). The Stim-V6RWPT of NSLBBP and SLBBP were significantly shorter than LVS(e)P (respectively, 67.1 ± 8.7 ms, 67.0 ± 9.3 ms, and 82.1 ± 10.9 ms). Stim-QRSend was the narrowest in IVSP2 (136.6 ± 15.2 ms) instead of NSLBBP (140.0 ± 17.1 ms). CONCLUSIONS The uninterrupted pacing technique for differentiating LBBP from LVS(e)P in the same group of patients is feasible. Electrophysiologic evidence from our intrapatient-controlled study shows that LBBP and LVS(e)P differ in ventricular electrical synchronization.
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Affiliation(s)
- Jiabo Shen
- Department of Cardiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Longfu Jiang
- Department of Cardiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.
| | - Hao Wu
- Department of Cardiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Xiaojie Cai
- Department of Cardiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Shanshan Zhuo
- Department of Cardiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Lifang Pan
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
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28
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O’Connor M, Riad O, Shi R, Hunnybun D, Li W, Jarman JWE, Foran J, Rinaldi CA, Markides V, Gatzoulis MA, Wong T. Left bundle branch area pacing in congenital heart disease. Europace 2022; 25:561-570. [PMID: 36358001 PMCID: PMC9935007 DOI: 10.1093/europace/euac175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/08/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Left bundle branch area pacing (LBBAP) has been shown to be effective and safe. Limited data are available on LBBAP in the congenital heart disease (CHD) population. This study aims to describe the feasibility and safety of LBBAP in CHD patients compared with non-CHD patients. METHODS AND RESULTS This is a single-centre, non-randomized observational study recruiting consecutive patients with bradycardia indication. Demographic data, ECGs, imaging, and procedural data including lead parameters were recorded. A total of 39 patients were included: CHD group (n = 13) and non-CHD group (n = 26). Congenital heart disease patients were younger (55 ± 14.5 years vs. 73.2 ± 13.1, P < 0.001). Acute success was achieved in all CHD patients and 96% (25/26) of non-CHD patients. No complications were encountered in either group. The procedural time for CHD patients was comparable (96.4 ± 54 vs. 82.1 ± 37.9 min, P = 0.356). Sheath reshaping was required in 7 of 13 CHD patients but only in 1 of 26 non-CHD patients, reflecting the complex and distorted anatomy of the patients in this group. Lead parameters were similar in both groups; R wave (11 ± 7 mV vs. 11.5 ± 7.5, P = 0.881) and pacing threshold (0.6 ± 0.3 V vs. 0.7 ± 0.3, P = 0.392). Baseline QRS duration was longer in the CHD group (150 ± 28.2 vs. 118.6 ± 26.6 ms, P = 0.002). Despite a numerically greater reduction in QRS and a similar left ventricular activation time (65.9 ± 6.2 vs. 67 ± 16.8 ms, P = 0.840), the QRS remained longer in the CHD group (135.5 ± 22.4 vs. 106.9 ± 24.7 ms, P = 0.005). CONCLUSION Left bundle branch area pacing is feasible and safe in CHD patients as compared to that in non-CHD patients. Procedural and fluoroscopy times did not differ between both groups. Lead parameters were satisfactory and stable over a short-term follow-up.
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Affiliation(s)
| | | | - Rui Shi
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
| | - Dan Hunnybun
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
| | - Wei Li
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK,Adult Congenital Heart Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Sydney Street, London SW3 6NP, UK
| | - Julian W E Jarman
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK,Adult Congenital Heart Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Sydney Street, London SW3 6NP, UK
| | - John Foran
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
| | | | - Vias Markides
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Sydney Street, London SW3 6NP, UK,National Heart & Lung Institute, Imperial College, London SW3 6LY, UK
| | - Tom Wong
- Corresponding author. Tel: +44 20 7352 8121; fax: +44 20 7351 8699. E-mail address:
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Jastrzębski M, Kiełbasa G, Cano O, Curila K, Heckman L, De Pooter J, Chovanec M, Rademakers L, Huybrechts W, Grieco D, Whinnett ZI, Timmer SAJ, Elvan A, Stros P, Moskal P, Burri H, Zanon F, Vernooy K. Left bundle branch area pacing outcomes: the multicentre European MELOS study. Eur Heart J 2022; 43:4161-4173. [PMID: 35979843 PMCID: PMC9584750 DOI: 10.1093/eurheartj/ehac445] [Citation(s) in RCA: 258] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 01/21/2023] Open
Abstract
AIMS Permanent transseptal left bundle branch area pacing (LBBAP) is a promising new pacing method for both bradyarrhythmia and heart failure indications. However, data regarding safety, feasibility and capture type are limited to relatively small, usually single centre studies. In this large multicentre international collaboration, outcomes of LBBAP were evaluated. METHODS AND RESULTS This is a registry-based observational study that included patients in whom LBBAP device implantation was attempted at 14 European centres, for any indication. The study comprised 2533 patients (mean age 73.9 years, female 57.6%, heart failure 27.5%). LBBAP lead implantation success rate for bradyarrhythmia and heart failure indications was 92.4% and 82.2%, respectively. The learning curve was steepest for the initial 110 cases and plateaued after 250 cases. Independent predictors of LBBAP lead implantation failure were heart failure, broad baseline QRS and left ventricular end-diastolic diameter. The predominant LBBAP capture type was left bundle fascicular capture (69.5%), followed by left ventricular septal capture (21.5%) and proximal left bundle branch capture (9%). Capture threshold (0.77 V) and sensing (10.6 mV) were stable during mean follow-up of 6.4 months. The complication rate was 11.7%. Complications specific to the ventricular transseptal route of the pacing lead occurred in 209 patients (8.3%). CONCLUSIONS LBBAP is feasible as a primary pacing technique for both bradyarrhythmia and heart failure indications. Success rate in heart failure patients and safety need to be improved. For wider use of LBBAP, randomized trials are necessary to assess clinical outcomes.
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Affiliation(s)
- Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Jakubowskiego 2, 30-688 Krakow, Poland
| | - Grzegorz Kiełbasa
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Jakubowskiego 2, 30-688 Krakow, Poland
| | - Oscar Cano
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Luuk Heckman
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
| | - Jan De Pooter
- Heart Center, Ghent University Hospital, Ghent, Belgium
| | - Milan Chovanec
- Department of Cardiology, Homolka Hospital, Prague, Czechia
| | - Leonard Rademakers
- Department of Cardiology, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Wim Huybrechts
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | | | | | - Stefan A J Timmer
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Arif Elvan
- Department of Cardiology, Isala Hospital Zwolle, Postbus 10400, 8000 GK Zwolle, the Netherlands
| | - Petr Stros
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Paweł Moskal
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Jakubowskiego 2, 30-688 Krakow, Poland
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Kevin Vernooy
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia
- Department of Cardiology, Radboud University Medical Centre (RadboudUMC), Nijmegen, the Netherlands
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Zhu K, Li L, Liu J, Chang D, Li Q. Criteria for differentiating left bundle branch pacing and left ventricular septal pacing: A systematic review. Front Cardiovasc Med 2022; 9:1006966. [PMID: 36247445 PMCID: PMC9562849 DOI: 10.3389/fcvm.2022.1006966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/13/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND As a novel physiological pacing technique, left bundle branch pacing (LBBP) can preserve the left ventricular (LV) electrical and mechanical synchronization by directly capturing left bundle branch (LBB). Approximately 60-90% of LBBP were confirmed to have captured LBB during implantation, implying that up to one-third of LBBP is actually left ventricular septal pacing (LVSP). LBB capture is critical for distinguishing LBBP from LVSP. METHODS AND RESULTS A total of 15 articles were included in the analysis by searching PubMed, EMBASE, Web of Science, and the Cochrane Library database till August 2022. Comparisons of paced QRS duration between LVSP and LBBP have not been uniformly concluded, but the stimulus artifact to LV activation time in lead V5 or V6 (Stim-LVAT) was shorter in LBBP than LVSP in all studies. Stim-LVAT was used to determine LBB capture with a sensitivity of 76-95.2% and specificity of 78.8-100%, which varied across patient populations. CONCLUSION The output-dependent QRS transition from non-selective LBBP to selective LBBP or LVSP is direct evidence of LBB capture. LBB potential combined with short Stim-LVAT can predict LBB capture better. Personalized criteria rather than a fixed value of Stim-LVAT are necessary to confirm LBB capture in different populations, especially in patients with LBB block or heart failure.
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Affiliation(s)
- Kailun Zhu
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
| | - Linlin Li
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jianghai Liu
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Dong Chang
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Qiang Li
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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(Conduction system pacing, classification, operation techniques, and methods used to confirm ventricular capture type in pacemaker implantation). COR ET VASA 2022. [DOI: 10.33678/cor.2022.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mizner J, Jurak P, Linkova H, Smisek R, Curila K. Ventricular Dyssynchrony and Pacing-induced Cardiomyopathy in Patients with Pacemakers, the Utility of Ultra-high-frequency ECG and Other Dyssynchrony Assessment Tools. Arrhythm Electrophysiol Rev 2022; 11:e17. [PMID: 35990106 PMCID: PMC9376832 DOI: 10.15420/aer.2022.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/09/2022] [Indexed: 11/23/2022] Open
Abstract
The majority of patients tolerate right ventricular pacing well; however, some patients manifest signs of heart failure after pacemaker implantation and develop pacing-induced cardiomyopathy. This is a consequence of non-physiological ventricular activation bypassing the conduction system. Ventricular dyssynchrony was identified as one of the main factors responsible for pacing-induced cardiomyopathy development. Currently, methods that would allow rapid and reliable ventricular dyssynchrony assessment, ideally during the implant procedure, are lacking. Paced QRS duration is an imperfect marker of dyssynchrony, and methods based on body surface mapping, electrocardiographic imaging or echocardiography are laborious and time-consuming, and can be difficult to use during the implantation procedure. However, the ventricular activation sequence can be readily displayed from the chest leads using an ultra-high-frequency ECG. It can be performed during the implantation procedure to visualise ventricular depolarisation and resultant ventricular dyssynchrony during pacing. This information can assist the electrophysiologist in selecting a pacing location that avoids dyssynchronous ventricular activation.
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Affiliation(s)
- Jan Mizner
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Pavel Jurak
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Hana Linkova
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Radovan Smisek
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Karol Curila
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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Song BX, Wang XX, An Y, Zhang YY. Left bundle branch pacing in a ventricular pacing dependent patient with heart failure: A case report. World J Clin Cases 2022; 10:7090-7096. [PMID: 36051124 PMCID: PMC9297394 DOI: 10.12998/wjcc.v10.i20.7090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/03/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Left bundle branch pacing (LBBP) is a physiological pacing method that has emerged in recent years. It is an ideal choice for patients with complete left bundle branch block who are in need of cardiac resynchronization therapy (CRT). Moreover, LBBP is superior in maintaining physiological ventricular activation and can effectively improve heart function and quality of life in patients with pacemaker-induced cardiomyopathy. However, LBBP in pacing-dependent patients who already have cardiac dysfunction has not been well assessed. CASE SUMMARY A 69-year-old male patient presented with symptoms of chest tightness, palpitation and systolic heart failure with New York Heart Association class III for 1 mo. The 12-lead electrocardiogram showed atrial fibrillation with third-degree atrioventricular block and ventricular premature beat. Holter revealed a right bundle branch block, atrial fibrillation with third-degree atrioventricular block, frequent multifocal ventricular premature beats, Ron-T and ventricular tachycardia. The echocardiogram documented an enlarged left atrium and left ventricle and a low left ventricular ejection fraction. Coronary angiography indicated a stenosis of 30% in the middle left anterior descending artery. Apparently, a CRT-D pacemaker was the best choice for this patient according to previous findings. However, the patient was worried about the financial burden. A single-chamber pacemaker with LBBP was selected, with the plan to take amiodarone and upgrade with dual-chamber implantable cardioverter-defibrillator or CRT-D at an appropriate time. During the follow-up at 3 mo after LBBP, the patient showed an improvement in cardiac function with slight improvement in echocardiography parameters, and the New York Heart Association functional class was maintained at I. Moreover, the patient no longer suffered from chest tightness and palpitation. Holter showed decreased ventricular arrhythmia of less than 5%. CONCLUSION LBBP might be used in patients with heart failure and a high-degree atrioventricular block as an alternative to conventional CRT.
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Affiliation(s)
- Bing-Xue Song
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Xia-Xia Wang
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Yi An
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Ying-Ying Zhang
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
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Byeon K, Kim HR, Park SJ, Park YJ, Choi JH, Kim JY, Park KM, On YK, Kim JS. Initial Experience with Left Bundle Branch Area Pacing with Conventional Stylet-Driven Extendable Screw-In Leads and New Pre-Shaped Delivery Sheaths. J Clin Med 2022; 11:jcm11092483. [PMID: 35566608 PMCID: PMC9104478 DOI: 10.3390/jcm11092483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 12/04/2022] Open
Abstract
Until recently, left bundle branch area pacing (LBBAp) has mostly been performed using lumen-less fixed screw leads. There are limited data on LBBAp with conventional style-driven extendable screw-in (SDES) leads, particularly data performed by operators with no previous experience with LBBAp procedures. In total, 42 consecutive patients undergoing LBBAp using SDES leads and newly designed delivery sheaths (LBBAp group) were compared with those treated with conventional right ventricular pacing (RVp) for atrioventricular block (RVp group, n = 84) using propensity score matching (1:2 ratio). The LBBAp was successful in 83% (35/42) of patients, with satisfactory pacing thresholds (0.8 ± 0.2 V at 0.4 ms). In the LBBAp group, the mean paced-QRS duration obtained during RV apical pacing (173 ± 18 ms) was significantly reduced by LBBAp (116 ± 14 ms, p < 0.001). Compared with the RVp group, the LBBAp group showed more physiological pacing, suggested by a much narrower paced-QRS duration (116 ± 14 vs. 151 ± 21 ms, p < 0.001). The pacing threshold was comparable in both groups. The LBBAp group revealed stable pacing thresholds for 6.8 ± 4.8 months post-implant and no serious complications including lead dislodgement or septal perforation. The novel approach of LBBAp using SDES leads and the new dedicated pre-shaped delivery sheaths was effectively and safely performed, even by inexperienced operators with LBBAp procedures.
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Affiliation(s)
- Kyeongmin Byeon
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong 14353, Korea;
| | - Hye Ree Kim
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju 52727, Korea;
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.-H.C.); (J.Y.K.); (K.-M.P.); (Y.K.O.); (J.S.K.)
- Correspondence: ; Tel.: +82-2-3410-7145; Fax: +82-2-3410-3849
| | - Young Jun Park
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
| | - Ji-Hoon Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.-H.C.); (J.Y.K.); (K.-M.P.); (Y.K.O.); (J.S.K.)
| | - Ju Youn Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.-H.C.); (J.Y.K.); (K.-M.P.); (Y.K.O.); (J.S.K.)
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.-H.C.); (J.Y.K.); (K.-M.P.); (Y.K.O.); (J.S.K.)
| | - Young Keun On
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.-H.C.); (J.Y.K.); (K.-M.P.); (Y.K.O.); (J.S.K.)
| | - June Soo Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.-H.C.); (J.Y.K.); (K.-M.P.); (Y.K.O.); (J.S.K.)
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A single-centre prospective evaluation of left bundle branch area pacemaker implantation characteristics. Neth Heart J 2022; 30:249-257. [PMID: 35380414 PMCID: PMC9043076 DOI: 10.1007/s12471-022-01679-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Left bundle branch area pacing (LBBAP) has recently been introduced as a physiological pacing technique with synchronous left ventricular activation. It was our aim to evaluate the feasibility and learning curve of the technique, as well as the electrical characteristics of LBBAP. Methods and results LBBAP was attempted in 80 consecutive patients and electrocardiographic characteristics were evaluated during intrinsic rhythm, right ventricular septum pacing (RVSP) and LBBAP. Permanent lead implantation was successful in 77 of 80 patients (96%). LBBAP lead implantation time and fluoroscopy time shortened significantly from 33 ± 16 and 21 ± 13 min to 17 ± 5 and 12 ± 7 min, respectively, from the first 20 to the last 20 patients. Left bundle branch (LBB) capture was achieved in 54 of 80 patients (68%). In 36 of 45 patients (80%) with intact atrioventricular conduction and narrow QRS, an LBB potential (LBBpot) was present with an LBBpot to onset of QRS interval of 22 ± 6 ms. QRS duration increased significantly more during RVSP (141 ± 20 ms) than during LBBAP (125 ± 19 ms), compared to 130 ± 30 ms without pacing. An even clearer difference was observed for QRS area, which increased significantly more during RVSP (from 32 ± 16 µVs to 73 ± 20 µVs) than during LBBAP (41 ± 15 µVs). QRS area was significantly smaller in patients with LBB capture compared to patients without LBB capture (43 ± 18 µVs vs 54 ± 21 µVs, respectively). In patients with LBB capture (n = 54), the interval from the pacing stimulus to R‑wave peak time in lead V6 was significantly shorter than in patients without LBB capture (75 ± 14 vs 88 ± 9 ms, respectively). Conclusion LBBAP is a safe and feasible technique, with a clear learning curve that seems to flatten after 40–60 implantations. LBB capture is achieved in two-thirds of patients. Compared to RVSP, LBBAP largely maintains ventricular electrical synchrony at a level close to intrinsic (narrow QRS) rhythm. Supplementary Information The online version of this article (10.1007/s12471-022-01679-7) contains supplementary material, which is available to authorized users.
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Zhu K, Chang D, Li Q. Which Is More Likely to Achieve Cardiac Synchronization: Left Bundle Branch Pacing or Left Ventricular Septal Pacing? Front Cardiovasc Med 2022; 9:845312. [PMID: 35419436 PMCID: PMC8997843 DOI: 10.3389/fcvm.2022.845312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kailun Zhu
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
| | - Dong Chang
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Qiang Li
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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Effect of left bundle branch pacing on left ventricular systolic function and synchronization in patients with third-degree atrioventricular block, assessment by 3- dimensional speckle tracking echocardiography. J Electrocardiol 2022; 72:61-65. [DOI: 10.1016/j.jelectrocard.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 11/24/2022]
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Okubo Y, Miyamoto S, Uotani Y, Ikeuchi Y, Miyauchi S, Okamura S, Tokuyama T, Nakano Y. Clinical impact of left bundle branch area pacing in heart failure with preserved ejection fraction and mid-range ejection fraction. Pacing Clin Electrophysiol 2022; 45:499-508. [PMID: 35179237 DOI: 10.1111/pace.14470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/06/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recently, conduction system pacing, including His bundle and left bundle branch area pacing (LBBAP), has emerged as an alternative pacing procedure for right ventricular (RV) pacing. The current study aimed to compare the clinical outcomes of LBBAP and conventional RV mid-septal pacing (RVMSP) in patients with heart failure (HF) with preserved ejection fraction (HFpEF) and HF with mid-range ejection (HFmrEF) requiring frequency RV pacing due to atrioventricular block (AVB). METHODS A total of 89 patients with HFpEF and HFmrEF requiring RV pacing due to symptomatic AVB were enrolled between September 2018 and April 2021, among whom 43 and 46 underwent LBBAP and RVMSP, respectively. RESULTS No significant differences in baseline characteristics were observed between the two groups. The LBBAP group had a significantly shorter paced-QRS duration and paced left ventricular activation time (LVAT) compared to the RVMSP group (123.4 ± 10.4 ms vs. 152.3 ± 12.3 ms, p < 0.001 and 68.3 ± 10.0 ms vs. 95.2 ± 12.3 ms, p < 0.001, respectively). The LBBAP group had significantly lower N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at the 6-month follow-up compared to the RVMSP group [459.6 pg/mL (240.4-678.7) vs. 972.7 pg/mL (629.5-1315.9), p = 0.01]. More patients in the LBBAP group exhibited a significant improvement in NT-proBNP, defined as a >50% decreased from baseline levels. CONCLUSION LBBAP maintains physiological ventricular activation and contributes to greater improvement in NT-proBNP value 6 months after implantation in patients with HFpEF and HFmrEF compared to RVMSP. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yousaku Okubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shogo Miyamoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukimi Uotani
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshihiro Ikeuchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shunsuke Miyauchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Sho Okamura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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39
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Peng XY, Wang YJ, Sun LL, Shi L, Cheng CD, Huang LH, Tian Y, Liu XP. Is the pacing site closer to the left ventricular septal endocardium in left bundle branch pacing or in left ventricular septal pacing? J Interv Card Electrophysiol 2022; 66:539-549. [PMID: 35146599 DOI: 10.1007/s10840-022-01143-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/30/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Distinguishing between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) is challenging. This study aimed to compare the echocardiographic distance from the pacing lead tip to the left ventricular (LV) septal endocardium between patients who underwent LBBP and those who underwent LVSP successfully. METHODS Fifty-nine consecutive patients (age 71.9 ± 12.0 years, 35.6% male) with traditional indications for permanent cardiac pacing were included (LBBP group, n = 46; LVSP group, n = 13). Unipolar pacing from the final pacing sites generated narrow QRS complexes with a right bundle branch block pattern in all patients. After the procedure, a physician blinded to the group allocation performed echocardiographic measurements of the distance between the lead tip and the LV septal endocardium. RESULTS The mean paced QRS duration was comparable between the LBBP group and the LVSP group (105.3 ± 15.6 ms vs. 109.2 ± 9.6 ms, P = 0.287). In the LBBP group, the interval from the left bundle branch potential to QRS onset was 28.7 ± 9.0 ms. During diastole, the mean distance between the lead tip and the LV septal endocardium was 0.6 ± 0.9 mm in the LBBP group and 3.0 ± 1.6 mm in the LVSP group (P < 0.001). During systole, the distance was 1.5 ± 1.4 mm in the LBBP group and 4.3 ± 2.6 mm in the LVSP group (P < 0.001). CONCLUSIONS The landing zone of the lead tip was closer to the LV septal endocardium in the patients who underwent LBBP. There is a need for real-time intraprocedural monitoring of the distance between the lead tip and the LV septal endocardium when performing LBBP.
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Affiliation(s)
- Xin-Yi Peng
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yan-Jiang Wang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Lan-Lan Sun
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Liang Shi
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Chao-Di Cheng
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Li-Hong Huang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Ying Tian
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Xing-Peng Liu
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
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40
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Meta-Analysis Comparing Safety and Efficacy of Left Bundle Branch Area Pacing Versus His Bundle Pacing. Am J Cardiol 2022; 164:64-72. [PMID: 34887071 DOI: 10.1016/j.amjcard.2021.10.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/22/2022]
Abstract
Although His bundle pacing (HBP) can provide a physiologic ventricular activation pattern, it has disadvantages such as the difficulty of lead implantation, reduced R wave amplitudes, and high and unstable pacing thresholds. Recent studies have demonstrated that left bundle branch area pacing (LBBaP) might overcome these deficiencies. A total of 7 nonrandomized controlled studies including 786 patients (n = 442 receiving LBBaP and n = 344 receiving HBP) with bradyarrhythmia were evaluated. Compared with HBP, LBBaP appeared to result in increased R wave amplitudes (at implant: MD 9.84 mV, 95% confidence interval [CI] 7.61 to 12.06 mV; at follow-up: MD 7.62 mV, 95% CI 6.73 to 8.50 mV), lowered capture thresholds (at implant: MD -0.73 V, 95% CI -0.81 to -0.64 V; at follow-up: MD -0.71 V, 95% CI -0.92 to -0.50 V), shortened procedure times (MD -16.70 minutes, 95% CI -26.51 to -6.90 minutes) and fluoroscopic durations (MD -6.16 min, 95% CI -8.28 to -4.03 minutes), and increased success rates (odds ratio 2.14, 95% CI 1.23 to 3.74); all of these differences were significant. However, paced QRS durations, the lead impedance at implantation and follow-up, and incidence of lead-related complications such as lead dislodgement did not significantly differ between LBBaP and HBP. In conclusion, current evidence suggests that LBBaP is a potential alternative to HBP as a pacing modality with which to maintain an ideal physiologic pattern of ventricular activation through native His-Purkinje system stimulation.
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41
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Liu X, Gu M, Niu HX, Chen X, Cai C, Zhao J, Cai M, Zhou X, Gold MR, Zhang S, Hua W. A Comparison of the Electrophysiological and Anatomic Characteristics of Pacing Different Branches of the Left Bundle Conduction System. Front Cardiovasc Med 2022; 8:781845. [PMID: 35071354 PMCID: PMC8766986 DOI: 10.3389/fcvm.2021.781845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Left bundle branch pacing (LBBP) is a rapidly growing conduction system pacing technique. However, little is known regarding the electrophysiological characteristics of different types of LBBP. We aimed to evaluate the electrophysiological characteristics and anatomic lead location with pacing different branches of the left bundle branch.Methods: Consecutive bradycardia patients with successful LBBP were enrolled and classified into groups according to the paced electrocardiogram and the lead location. Electrocardiogram, pacing properties, vectorcardiogram, and lead tip location were analyzed.Results: Ninety-one patients were enrolled, including 48 with the left bundle trunk pacing (LBTP) and 43 with the left bundle fascicular pacing (LBFP). The paced QRS duration in the LBTP group was significantly shorter than that in the LBFP group (108.1 ± 9.9 vs. 112.9 ± 11.2 ms, p = 0.03), with a more rightward QRS transition zone (p = 0.01). The paced QRS area in the LBTP group was similar to that during intrinsic rhythm (35.1 ± 15.8 vs. 34.7 ± 16.6 μVs, p = 0.98), whereas in the LBFP group, the paced QRS area was significantly larger compared to intrinsic rhythm (43.4 ± 15.8 vs. 35.7 ± 18.0 μVs, p = 0.01). The lead tip site for LBTP was located in a small fan-shaped area with the tricuspid valve annulus summit as the origin, whereas fascicular pacing sites were more likely in a larger and more distal area.Conclusions: Pacing the proximal left bundle main trunk produced better electrical synchrony compared with pacing the distal left bundle fascicles. A visualization technique can facilitate achieving LBTP.
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Affiliation(s)
- Xi Liu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Gu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Xia Niu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuhua Chen
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chi Cai
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junhan Zhao
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minsi Cai
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohong Zhou
- Cardiac Rhythm and Heart Failure Division, Medtronic plc, Minneapolis, MN, United States
| | - Michael R. Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, United States
| | - Shu Zhang
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Hua
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Wei Hua
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Curila K, Jurak P, Vernooy K, Jastrzebski M, Waldauf P, Prinzen F, Halamek J, Susankova M, Znojilova L, Smisek R, Karch J, Plesinger F, Moskal P, Heckman L, Mizner J, Viscor I, Vondra V, Leinveber P, Osmancik P. Left Ventricular Myocardial Septal Pacing in Close Proximity to LBB Does Not Prolong the Duration of the Left Ventricular Lateral Wall Depolarization Compared to LBB Pacing. Front Cardiovasc Med 2021; 8:787414. [PMID: 34950718 PMCID: PMC8688808 DOI: 10.3389/fcvm.2021.787414] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Three different ventricular capture types are observed during left bundle branch pacing (LBBp). They are selective LBB pacing (sLBBp), non-selective LBB pacing (nsLBBp), and myocardial left septal pacing transiting from nsLBBp while decreasing the pacing output (LVSP). Study aimed to compare differences in ventricular depolarization between these captures using ultra-high-frequency electrocardiography (UHF-ECG). Methods: Using decremental pacing voltage output, we identified and studied nsLBBp, sLBBp, and LVSP in patients with bradycardia. Timing of ventricular activations in precordial leads was displayed using UHF-ECGs, and electrical dyssynchrony (e-DYS) was calculated as the difference between the first and last activation. The durations of local depolarizations (Vd) were determined as the width of the UHF-QRS complex at 50% of its amplitude. Results: In 57 consecutive patients, data were collected during nsLBBp (n = 57), LVSP (n = 34), and sLBBp (n = 23). Interventricular dyssynchrony (e-DYS) was significantly lower during LVSP −16 ms (−21; −11), than nsLBBp −24 ms (−28; −20) and sLBBp −31 ms (−36; −25). LVSP had the same V1d-V8d as nsLBBp and sLBBp except for V3d, which during LVSP was shorter than sLBBp; the mean difference −9 ms (−16; −1), p = 0.01. LVSP caused less interventricular dyssynchrony and the same or better local depolarization durations than nsLBBp and sLBBp irrespective of QRS morphology during spontaneous rhythm or paced QRS axis. Conclusions: In patients with bradycardia, LVSP in close proximity to LBB resulted in better interventricular synchrony than nsLBBp and sLBBp and did not significantly prolong depolarization of the left ventricular lateral wall.
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Affiliation(s)
- Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Pavel Jurak
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czechia
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Marek Jastrzebski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Petr Waldauf
- Department of Anesthesia and Intensive Care, Charles University, University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Frits Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Josef Halamek
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czechia
| | - Marketa Susankova
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Lucie Znojilova
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Radovan Smisek
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czechia.,Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Brno, Czechia
| | - Jakub Karch
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Filip Plesinger
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czechia
| | - Pawel Moskal
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Luuk Heckman
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Jan Mizner
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Ivo Viscor
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czechia
| | - Vlastimil Vondra
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czechia
| | - Pavel Leinveber
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czechia
| | - Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czechia
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Heckman L, Luermans J, Salden F, van Stipdonk AMW, Mafi-Rad M, Prinzen F, Vernooy K. Physiology and Practicality of Left Ventricular Septal Pacing. Arrhythm Electrophysiol Rev 2021; 10:165-171. [PMID: 34777821 PMCID: PMC8576493 DOI: 10.15420/aer.2021.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/08/2021] [Indexed: 02/01/2023] Open
Abstract
Left ventricular septal pacing (LVSP) and left bundle branch pacing (LBBP) have been introduced to maintain or correct interventricular and intraventricular (dys)synchrony. LVSP is hypothesised to produce a fairly physiological sequence of activation, since in the left ventricle (LV) the working myocardium is activated first at the LV endocardium in the low septal and anterior free-wall regions. Animal studies as well as patient studies have demonstrated that LV function is maintained during LVSP at levels comparable to sinus rhythm with normal conduction. Left ventricular activation is more synchronous during LBBP than LVSP, but LBBP produces a higher level of intraventricular dyssynchrony compared to LVSP. While LVSP is fairly straightforward to perform, targeting the left bundle branch area may be more challenging. Long-term effects of LVSP and LBBP are yet to be determined. This review focuses on the physiology and practicality of LVSP and provides a guide for permanent LVSP implantation.
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Affiliation(s)
- Luuk Heckman
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Justin Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), the Netherlands.,Department of Cardiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
| | - Floor Salden
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), the Netherlands
| | | | - Masih Mafi-Rad
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), the Netherlands
| | - Frits Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), the Netherlands.,Department of Cardiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
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