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Shimeno K, Matsumoto N, Tamura S, Matsuo M, Hayashi Y, Abe Y, Fukuda D. Durability of output-dependent QRS transition and left bundle branch capture in left bundle branch area pacing. Heart Rhythm 2024:S1547-5271(24)03237-5. [PMID: 39181484 DOI: 10.1016/j.hrthm.2024.08.039] [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: 05/19/2024] [Revised: 08/11/2024] [Accepted: 08/17/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Although output-dependent QRS transition is a specific indicator that confirms left bundle branch (LBB) capture during left bundle branch area pacing (LBBAP), its durability remains unclear. OBJECTIVE To evaluate the presence of output-dependent QRS transition and capture thresholds of the LBB and left ventricular septal myocardium (LVS) immediately and up to 1 year after the LBBAP procedure. METHODS We enrolled 129 patients with successful LBBAP who were available for 1-year follow-up postoperatively. Threshold testing was performed immediately after LBBAP on postoperative day 0 (POD-0), after three days (POD-3), 6 months (POD-180), and 1 year (POD-360). RESULTS Output-dependent QRS transition persisted in 64 (88%) patients on POD-360, from amongst the 73 patients with output-dependent QRS transition on POD-0. In contrast, 55 (98%) of 56 patients without QRS transition on POD-0 did not exhibit QRS transition thereafter. LBB thresholds were slightly elevated on POD-360, albeit without statistical significance, compared to those on POD-0 (1.22 ± 1.00 vs. 1.43 ± 1.29 V at 0.4 ms, p=0.26). The LBB thresholds increased by ≥1.5 V in 7 (11%) patients. However, in 93% of patients with an LBB threshold of ≤2.5 V on POD-0, LBB capture was maintained at 2.5 V on POD-360. LVS thresholds were similar on POD-0 and POD-360 (0.81 ± 0.36 vs. 0.83 ± 0.24 V, p=1.0), and did not increase by ≥1.5 V in any patient. CONCLUSION Output-dependent QRS transitions were highly reproducible after implantation. Furthermore, LBB thresholds remained stable in most cases during the first postoperative year.
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Affiliation(s)
- Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan.
| | - Naoki Matsumoto
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan.
| | - Shota Tamura
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
| | - Masanori Matsuo
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan.
| | - Yusuke Hayashi
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan.
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan.
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
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Wei F, Kuang X, Zhang X, Wu P, Fan J. Ventricular activation pattern of left ventricular septal pacing in a canine model. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01903-x. [PMID: 39145792 DOI: 10.1007/s10840-024-01903-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/09/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Left bundle branch pacing (LBBP) is a feasible and effective physiological pacing technique. The QRS morphology of left ventricular septal pacing (LVSP) is similar to that of LBBP. The ventricular activation pattern of LBBP is well-known, whereas the pattern of LVSP still needs further investigation. The present study aimed to determine ventricular activation pattern difference between LVSP and LBBP in a canine model. METHOD All six canines underwent successful LBBP and LVSP through trans-ventricular septum using intracardiac echocardiography and intracardiac electrogram. Their hearts were isolated and stained with Lugol's iodine to determine the position of the pacing lead. The activation sequences of the left ventricular myocardium and His-Purkinje system were recorded by placing multiple electrode catheters. RESULTS First, the left His-Purkinje system in LVSP was activated simultaneously from apical and basal regions to the left ventricular middle septal region, whereas the left ventricular septal myocardium was activated from the apical to basal region. The left His-Purkinje system activation in LBBP occurred in the direction of the apex from the pacing lead, but the left ventricular septal myocardium was activated in the apical to basal direction. Furthermore, the left intraventricular electrical synchrony was similar between LVSP and LBBP as determined by mapping the left ventricular septal to free wall activation time (46.7 ± 1.8 ms vs. 45.0 ± 1.4 ms, p = 0.11). CONCLUSION The ventricular activation sequence of LVSP was similar to LBBP. LVSP can capture LBB due to the wide distribution of LBB. These findings suggest a rationale for clinical application of LVSP.
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Affiliation(s)
- Feiyu Wei
- Department of Cardiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, 157 Jinbi Road, 650032, Kunming, Yunnan Province, People's Republic of China
| | - Xiaohui Kuang
- Department of Cardiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, 157 Jinbi Road, 650032, Kunming, Yunnan Province, People's Republic of China
| | - Xi Zhang
- Department of Cardiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, 157 Jinbi Road, 650032, Kunming, Yunnan Province, People's Republic of China
| | - Peng Wu
- Department of Cardiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, 157 Jinbi Road, 650032, Kunming, Yunnan Province, People's Republic of China
| | - Jie Fan
- Department of Cardiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, 157 Jinbi Road, 650032, Kunming, Yunnan Province, People's Republic of China.
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Jastrzębski M, Vijayaraman P. A step forward toward conduction system pacing-based cardiac resynchronization therapy, albeit a small one. Heart Rhythm 2024; 21:901-902. [PMID: 38367892 DOI: 10.1016/j.hrthm.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/19/2024]
Affiliation(s)
- Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland.
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Ramalingam V, Ponnusamy S, Abdulkader RS, Murugan S, Mariyappan S, Kathiresan J, Kumar M, Anand V. Is left bundle branch pacing (LBBP) associated with better depolarization and repolarization kinetics than right ventricular mid septal pacing (RVSP)? - Comparison of frontal QRS -T angle in patients with LBBP, RVSP and normal ventricular conduction. Indian Pacing Electrophysiol J 2024; 24:75-83. [PMID: 38151159 PMCID: PMC11010446 DOI: 10.1016/j.ipej.2023.12.004] [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: 07/12/2023] [Revised: 10/08/2023] [Accepted: 12/19/2023] [Indexed: 12/29/2023] Open
Abstract
AIMS To assess the frontal QRS- T angle (f QRS- T angle) in patients with left bundle branch pacing (LBBP) as compared to right ventricular mid septal pacing (RVSP) implanted for symptomatic high degree atrioventricular (AV) block and to compare with control subjects with normal ventricular conduction (CSNVC) METHODS: A total of one-fifty subjects were chosen (50 patients with LBBP, 50 patients with RVSP and 50 CSNVC). The indication for pacemaker implantation was symptomatic high degree AV block. Baseline clinical and electrocardiogram (ECG) parameters like QRS duration (QRSD), QRS axis and f QRS-T angle and Ejection Fraction (EF) were assessed. f QRS-T angle was measured as the difference between the computerised mean frontal QRS and T wave axes in the limb leads. If the difference between the QRS axis and T-wave axis exceeds 180°, then the resultant QRS-T angle would be calculated as 360° minus the absolute angle to obtain a value between 0° and 180°. Baseline, immediate post procedural and 6 month follow up (f/u) ECGs and EF were chosen for the analysis. RESULTS Patients who underwent LBBP had significantly shorter paced QRSD than patients who had undergone RVSP (112 ± 12 ms vs 146 ± 13 ms; 95 % confidence interval (CI): 43, -31; p<0.001). There was no significant difference in the QRSD before and after LBBP. The QRSD before and after pacing in RVSP was 111 ± 27 ms and 146 ± 13 ms; 95 % CI: 43, -28; p < 0.001. The QRSD in control patients with NVC was 82.94 ± 9.59 ms. RVSP was associated with wider f QRS-T angle when compared with LBBP (103 ± 53° vs 82 ± 43°; 95 % CI: 39, -1.0; p = 0.037). The baseline and immediate post procedure f QRS-T angle in LBBP was 70 ± 48° and 82 ± 43°; 95 % CI: 31, 5.3; p = 0.2. At 6 months f/u, the f QRS-T angle was 61 ± 43°; 95 % CI: 8.5, 35; p=0.002. The baseline and immediate post procedure f QRS-T angle in RVSP was 67 ± 51° and 103 ± 53°; 95 % CI: 54, -17; p < 0.001. At 6 months f/u, the f QRS-T angle in RVSP group was 87 ± 58°; 95 % CI: 2.6, 29; p = 0.020. The f QRS T angle in control patients with NVC was 24 ± 16°. When subgroup analysis was done the difference in the f QRS-T angle was significant between RVSP and LBBP groups only in patients who had wide QRS escape. The mean LVEF at 6-month follow-up in LBBP vs RVSP was 61 ± 3.7 % vs 57.1 ± 7.8 %; 95 % CI:1.48, 6.32, p = 0.002. In the RVSP group, three patients developed pacing induced cardiomyopathy (PIC) whereas no patients in the LBBP group developed PIC at 6-month follow-up; p=0.021. One patient with PIC had deterioration of functional status with new onset HF symptoms. The patient symptoms improved with medical therapy and needed no hospitalisation. The patient declined further interventions including upgradation to CRT or LBB pacing. No deaths or ventricular arrhythmias were observed during the study period. CONCLUSION LBBP is associated with narrower f QRS-T angle as compared to RVSP both at post implant period and at 6 month f/u period. These findings might be due to the more physiological depolarization and repolarization kinetics associated with LBBP. RVSP was associated with 6 % incidence of PIC. Hence wide f QRS-T angle might be a predictor of PIC.
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Affiliation(s)
- Vadivelu Ramalingam
- Department of Cardiology, Velammal Medical College Hospital, Madurai, 625009, Tamil Nadu, India.
| | | | - Rizwan Suliankatchi Abdulkader
- National Institute of Epidemiology, Indian Council of Medical Research, Second Main Road, Tamil Nadu Housing Board, Ayapakkam, Chennai, 600077, Tamil Nadu, India
| | - Senthil Murugan
- Department of Cardiology, Velammal Medical College Hospital, Madurai, 625009, Tamil Nadu, India
| | - Selvaganesh Mariyappan
- Department of Cardiology, Velammal Medical College Hospital, Madurai, 625009, Tamil Nadu, India
| | - Jeyashree Kathiresan
- National Institute of Epidemiology, Indian Council of Medical Research, Second Main Road, Tamil Nadu Housing Board, Ayapakkam, Chennai, 600077, Tamil Nadu, India
| | - Mahesh Kumar
- Department of Cardiology, Velammal Medical College Hospital, Madurai, 625009, Tamil Nadu, India
| | - Vijesh Anand
- Department of Cardiology, Velammal Medical College Hospital, Madurai, 625009, Tamil Nadu, India
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Cano Ó, Jover P, Ayala HD, Navarrete-Navarro J, Osca J, Izquierdo M, Navarro J, Martínez-Dolz L. Left bundle branch pacing versus left ventricular septal pacing as a primary procedural endpoint during left bundle branch area pacing: Evaluation of two different implant strategies. J Cardiovasc Electrophysiol 2024; 35:120-129. [PMID: 37962088 DOI: 10.1111/jce.16128] [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: 08/12/2023] [Revised: 10/12/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Implant procedure features and clinical implications of left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) have not been yet fully described. We sought to compare two different left bundle branch area pacing (LBBAP) implant strategies: the first one accepting LVSP as a procedural endpoint and the second one aiming at achieving LBBP in every patient in spite of evidence of previous LVSP criteria. METHODS LVSP was accepted as a procedural endpoint in 162 consecutive patients (LVSP strategy group). In a second phase, LBBP was attempted in every patient in spite of achieving previous LVSP criteria (n = 161, LBBP strategy group). Baseline patient characteristics, implant procedure, and follow-up data were compared. RESULTS The final capture pattern was LBBP in 71.4% and LVSP in 24.2% in the LBBP strategy group compared to 42.7% and 50%, respectively, in the LVSP strategy group. One hundred and eighty-four patients (57%) had proven LBB capture criteria with a significantly shorter paced QRS duration than the 120 patients (37%) with LVSP criteria (115 ± 9 vs. 121 ± 13 ms, p < .001). Implant parameters were comparable between the two strategies but the LBBP strategy resulted in a higher rate of acute septal perforation (11.8% vs. 4.9%, p = .026) without any clinical sequelae. Patients with CRT indications significantly improved left ventricular ejection fraction (LVEF) during follow-up irrespective of the capture pattern (from 35 ± 11% to 45 ± 14% in proven LBBP, p = .024; and from 39 ± 13% to 47 ± 12% for LVSP, p = .003). The presence of structural heart disease and baseline LBBB independently predicted unsuccessful LBB capture. CONCLUSION The LBBP strategy was associated with comparable implant parameters than the LVSP strategy but resulted in higher rates of septal perforation. Proven LBB capture and LVSP showed comparable effects on LVEF during follow-up.
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Affiliation(s)
- Óscar Cano
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Spain
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Pablo Jover
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Hebert D Ayala
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Javier Navarrete-Navarro
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Joaquín Osca
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Spain
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Maite Izquierdo
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Spain
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Josep Navarro
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Luis Martínez-Dolz
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Spain
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
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Hopman LHGA, Beunder KP, Borodzicz-Jazdzyk S, Götte MJW, van Halm VP. Loss of capture of conduction system pacemaker caused by fibrosis surrounding the lead: a case report. BMC Cardiovasc Disord 2023; 23:621. [PMID: 38114911 PMCID: PMC10729341 DOI: 10.1186/s12872-023-03656-3] [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: 09/06/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Conduction system pacing (CSP) is a novel technique that involves pacing the His-Purkinje system instead of the traditional right ventricular (RV) apex. This technique aims to avoid the adverse effects of RV apical pacing, which can lead to ventricular dyssynchrony and heart failure over time. CSP is gaining popularity but its long-term efficacy and challenges remain uncertain. This report discusses a case where CSP was initially successful but faced complications due to an increasing pacing threshold. CASE PRESENTATION A 65-year-old female with total atrioventricular block was referred for brady-pacing. Due to the potential for chronic RV pacing, CSP was chosen. The CSP implantation involved subcutaneous device placement, with a CSP lead in the left bundle branch area (LBBA) and an RV backup lead. A year after successful implantation, the LBBA pacing threshold progressively increased. Subsequent efforts to correct it led to anodal capture and battery depletion. Cardiac magnetic resonance imaging (CMR) revealed mid-septal fibrosis at the area of LBBA lead placement and suggested cardiac sarcoidosis as a possible cause. CONCLUSION CSP is a promising technique for treating bradyarrhythmias, but this case underscores the need for vigilance in monitoring pacing thresholds. Increasing thresholds can render CSP ineffective, necessitating alternative pacing methods. The CMR findings of mid-septal fibrosis and the potential diagnosis of cardiac sarcoidosis emphasize the importance of pre-implantation assessment, as CSP may be compromised by underlying structural abnormalities. This report highlights the complexities of pacing strategy selection and the significance of comprehensive evaluation before adopting CSP.
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Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Kyle P Beunder
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sonia Borodzicz-Jazdzyk
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Vokko P van Halm
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
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Burri H, Vijayaraman P. A new era of physiologic cardiac pacing. Eur Heart J Suppl 2023; 25:G1-G3. [PMID: 37970520 PMCID: PMC10637834 DOI: 10.1093/eurheartjsupp/suad120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Affiliation(s)
- Haran Burri
- Cardiology Department, Cardiac Pacing Unit, University Hospital of Geneva, Geneva, Switzerland
| | - Pugazhendhi Vijayaraman
- Division of Cardiac Electrophysiology, Geisinger Heart Institute, Geisinger Wyoming Valley Medical Center, 1000 E Mountain blvd, Wilkes-Barre, PA 18711, USA
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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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Jastrzebski M, Dandamudi G, Burri H, Ellenbogen KA. Conduction system pacing: overview, definitions, and nomenclature. Eur Heart J Suppl 2023; 25:G4-G14. [PMID: 37970514 PMCID: PMC10637837 DOI: 10.1093/eurheartjsupp/suad114] [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
Pacing from the right ventricle is associated with an increased risk of development of congestive heart failure, increases in total and cardiac mortality, and a worsened quality of life. Conduction system pacing has become increasingly realized as an alternative to right ventricular apical pacing. Conduction system pacing from the His bundle and left bundle branch area has been shown to provide physiologic activation of the ventricle and may be an alternative to coronary sinus pacing. Conduction system pacing has been studied as an alternative for both bradycardia pacing and for heart failure pacing. In this review, we summarize the clinical results of conduction system pacing under a variety of different clinical settings. The anatomic targets of conduction system pacing are illustrated, and electrocardiographic correlates of pacing from different sites in the conduction system are defined. Ultimately, clinical trials comparing conduction system pacing with standard right ventricular apical pacing and cardiac resynchronization therapy pacing will help define its benefit and risks compared with existing techniques.
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Affiliation(s)
- Marek Jastrzebski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Jakubowskiego 2, 30-688 Krakow, Poland
| | - Gopi Dandamudi
- Center for Cardiovascular Health, Virginia Mason Franciscan Heath, Seattle, WA, USA
| | - Haran Burri
- Cardiac Pacing Unit, University Hospital of Geneva, Geneva, Switzerland
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Vijayaraman P, Chelu MG, Curila K, Dandamudi G, Herweg B, Mori S, Jastrzebski M, Sharma PS, Shivkumar K, Tung R, Upadhyay G, Vernooy K, Welter-Frost A, Whinnett Z, Zanon F, Ellenbogen KA. Cardiac Conduction System Pacing: A Comprehensive Update. JACC Clin Electrophysiol 2023; 9:2358-2387. [PMID: 37589646 DOI: 10.1016/j.jacep.2023.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 06/02/2023] [Indexed: 08/18/2023]
Abstract
The field of cardiac pacing has changed rapidly in the last several years. Since the initial description of His bundle pacing targeting the conduction system, recent advances in pacing the left bundle branch and its fascicles have evolved. The field and investigators' knowledge of conduction system pacing including relevant anatomy and physiology has advanced significantly. The aim of this review is to provide a comprehensive update on recent advances in conduction system pacing.
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Affiliation(s)
- Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA.
| | - Mihal G Chelu
- Division of Cardiology, Baylor College of Medicine and Baylor St. Luke's Medical Center and Texas Heart Institute, Houston, Texas, USA
| | - Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Gopi Dandamudi
- Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Bengt Herweg
- University of South Florida Morsani College of Medicine, Department of Cardiovascular Sciences, Tampa, Florida, USA
| | - Shumpei Mori
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Marek Jastrzebski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Parikshit S Sharma
- Department of Cardiology, Rush University School of Medicine, Chicago, Illinois, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Roderick Tung
- Division of Cardiology, University of Arizona College of Medicine-Phoenix, Banner-University Medical Center, Phoenix, Arizona, USA
| | - Gaurav Upadhyay
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kevin Vernooy
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago, Chicago, Illinois, USA
| | - Allan Welter-Frost
- Cleveland Clinic Indian River Hospital, Heart Vascular and Thoracic Institute, Vero Beach, Florida, USA
| | - Zachary Whinnett
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Kenneth A Ellenbogen
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Kato H, Sato T, Shimeno K, Mito S, Nishida T, Soejima K. Predictors of implantation failure in left bundle branch area pacing using a lumenless lead in patients with bradycardia. J Arrhythm 2023; 39:766-775. [PMID: 37799795 PMCID: PMC10549844 DOI: 10.1002/joa3.12906] [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: 06/14/2023] [Revised: 07/12/2023] [Accepted: 07/23/2023] [Indexed: 10/07/2023] Open
Abstract
Background Left bundle branch area pacing (LBBAP) is a novel conduction system pacing technique. In this multicenter study, we aimed to evaluate the procedural success, safety, and preoperative predictors of procedural failure of LBBAP. Methods LBBAP was attempted in 285 patients with pacemaker indications for bradyarrhythmia, which were mainly atrioventricular block (AVB) (68.1%) and sick sinus syndrome (26.7%). Procedural success and electrophysiological and echocardiographic parameters were evaluated. Results LBBAP was successful in 247 (86.7%) patients. Left bundle branch (LBB) capture was confirmed in 54.7% of the population. The primary reasons for procedural failure were the inability of the pacemaker lead to penetrate deep into the septum (76.3%) and failure to achieve shortening of stimulus to left ventricular (LV) activation time in lead V6 (18.4%). Thickened interventricular septum (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.15-5.35), severe tricuspid regurgitation (OR, 8.84; 95% CI, 1.22-64.06), and intraventricular conduction delay (OR, 8.16; 95% CI, 2.32-28.75) were preoperative predictors of procedural failure. The capture threshold and ventricular amplitude remained stable, and no major complications occurred throughout the 2-year follow-up. In patients with ventricular pacing burden >40%, the LV ejection fraction remained high regardless of LBB capture. Conclusions Successful LBBAP was affected by abnormal cardiac anatomy and intraventricular conduction. LBBAP is feasible and safe as a primary strategy for patients with AVB, depending on ventricular pacing.
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Affiliation(s)
- Hiroyuki Kato
- Department of Cardiology, Japan Community Healthcare Organization Chukyo HospitalNagoyaJapan
| | - Toshiaki Sato
- Division of Advanced Arrhythmia ManagementKyorin University School of MedicineMitakaJapan
| | - Kenji Shimeno
- Department of Cardiology, Osaka City General HospitalOsakaJapan
| | - Shinji Mito
- Department of Cardiology, Chikamori HospitalKochiJapan
| | - Taku Nishida
- Department of Cardiovascular MedicineNara Medical UniversityKashiharaJapan
| | - Kyoko Soejima
- Department of Cardiovascular MedicineKyorin University School of MedicineMitakaJapan
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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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13
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Ellenbogen KA, Auricchio A, Burri H, Gold MR, Leclercq C, Leyva F, Linde C, Jastrzebski M, Prinzen F, Vernooy K. The evolving state of cardiac resynchronization therapy and conduction system pacing: 25 years of research at EP Europace journal. Europace 2023; 25:euad168. [PMID: 37622580 PMCID: PMC10450796 DOI: 10.1093/europace/euad168] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 08/26/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) was proposed in the 1990s as a new therapy for patients with heart failure and wide QRS with depressed left ventricular ejection fraction despite optimal medical treatment. This review is aimed first to describe the rationale and the physiologic effects of CRT. The journey of the landmark randomized trials leading to the adoption of CRT in the guidelines since 2005 is also reported showing the high level of evidence for CRT. Different alternative pacing modalities of CRT to conventional left ventricular pacing through the coronary sinus have been proposed to increase the response rate to CRT such as multisite pacing and endocardial pacing. A new emerging alternative technique to conventional biventricular pacing, conduction system pacing (CSP), is a promising therapy. The different modalities of CSP are described (Hirs pacing and left bundle branch area pacing). This new technique has to be evaluated in clinical randomized trials before implementation in the guidelines with a high level of evidence.
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Affiliation(s)
- Kenneth A Ellenbogen
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Angelo Auricchio
- Division of Cardiology, Università della Svizzera Italiana and Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Francisco Leyva
- Aston University, Birmingham NHS Trust at Queen Elizabeth Hospital, Birmingham, UK
| | - Cecilia Linde
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Marek Jastrzebski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Frits Prinzen
- Physiology, Maastricht University Medical Center, 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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14
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Sussenbek O, Rademakers L, Waldauf P, Jurak P, Smisek R, Stros P, Poviser L, Vesela J, Plesinger F, Halamek J, Leinveber P, Herman D, Osmancik P, Curila K. Left bundle branch area pacing results in more physiological ventricular activation than biventricular pacing in patients with left bundle branch block heart failure. Eur Heart J Suppl 2023; 25:E17-E24. [PMID: 37234235 PMCID: PMC10206755 DOI: 10.1093/eurheartjsupp/suad109] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Biventricular pacing (Biv) and left bundle branch area pacing (LBBAP) are methods of cardiac resynchronization therapy (CRT). Currently, little is known about how they differ in terms of ventricular activation. This study compared ventricular activation patterns in left bundle branch block (LBBB) heart failure patients using an ultra-high-frequency electrocardiography (UHF-ECG). This was a retrospective analysis including 80 CRT patients from two centres. UHF-ECG data were obtained during LBBB, LBBAP, and Biv. Left bundle branch area pacing patients were divided into non-selective left bundle branch pacing (NSLBBP) or left ventricular septal pacing (LVSP) and into groups with V6 R-wave peak times (V6RWPT) < 90 ms and ≥ 90 ms. Calculated parameters were: e-DYS (time difference between the first and last activation in V1-V8 leads) and Vdmean (average of V1-V8 local depolarization durations). In LBBB patients (n = 80) indicated for CRT, spontaneous rhythms were compared with Biv (39) and LBBAP rhythms (64). Although both Biv and LBBAP significantly reduced QRS duration (QRSd) compared with LBBB (from 172 to 148 and 152 ms, respectively, both P < 0.001), the difference between them was not significant (P = 0.2). Left bundle branch area pacing led to shorter e-DYS (24 ms) than Biv (33 ms; P = 0.008) and shorter Vdmean (53 vs. 59 ms; P = 0.003). No differences in QRSd, e-DYS, or Vdmean were found between NSLBBP, LVSP, and LBBAP with paced V6RWPTs < 90 and ≥ 90 ms. Both Biv CRT and LBBAP significantly reduce ventricular dyssynchrony in CRT patients with LBBB. Left bundle branch area pacing is associated with more physiological ventricular activation.
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Affiliation(s)
| | - Leonard Rademakers
- Department of Cardiology, Catharina Ziekenhuis, 5602 ZA Eindhoven, The Netherlands
| | - Petr Waldauf
- Department of Anesthesia and Intensive Care, Charles University, University Hospital Kralovske Vinohrady, Prague 10034, Czechia
| | - Pavel Jurak
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno 61200, Czechia
| | - Radovan Smisek
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno 61200, Czechia
| | - Petr Stros
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 1150/50, Praha 10, Prague 10034, Czechia
| | - Lukas Poviser
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 1150/50, Praha 10, Prague 10034, Czechia
| | - Jana Vesela
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 1150/50, Praha 10, Prague 10034, Czechia
| | - Filip Plesinger
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno 61200, Czechia
| | - Josef Halamek
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno 61200, Czechia
| | - Pavel Leinveber
- International Clinical Research Center, St. Anne’s University Hospital, Brno 60200, Czechia
| | - Dalibor Herman
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 1150/50, Praha 10, Prague 10034, Czechia
| | - Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 1150/50, Praha 10, Prague 10034, Czechia
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15
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Keene D, Anselme F, Burri H, Pérez ÓC, Čurila K, Derndorfer M, Foley P, Gellér L, Glikson M, Huybrechts W, Jastrzebski M, Kaczmarek K, Katsouras G, Lyne J, Verdú PP, Restle C, Richter S, Timmer S, Vernooy K, Whinnett Z. Conduction system pacing, a European survey: insights from clinical practice. Europace 2023; 25:euad019. [PMID: 36916199 PMCID: PMC10227660 DOI: 10.1093/europace/euad019] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/06/2023] [Indexed: 03/14/2023] Open
Abstract
AIMS The field of conduction system pacing (CSP) is evolving, and our aim was to obtain a contemporary picture of European CSP practice. METHODS AND RESULTS A survey was devised by a European CSP Expert Group and sent electronically to cardiologists utilizing CSP. A total of 284 physicians were invited to contribute of which 171 physicians (60.2%; 85% electrophysiologists) responded. Most (77%) had experience with both His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP). Pacing indications ranked highest for CSP were atrioventricular block (irrespective of left ventricular ejection fraction) and when coronary sinus lead implantation failed. For patients with left bundle branch block (LBBB) and heart failure (HF), conventional biventricular pacing remained first-line treatment. For most indications, operators preferred LBBAP over HBP as a first-line approach. When HBP was attempted as an initial approach, reasons reported for transitioning to utilizing LBBAP were: (i) high threshold (reported as >2 V at 1 ms), (ii) failure to reverse bundle branch block, or (iii) > 30 min attempting to implant at His-bundle sites. Backup right ventricular lead use for HBP was low (median 20%) and predominated in pace-and-ablate scenarios. Twelve-lead electrocardiogram assessment was deemed highly important during follow-up. This, coupled with limitations from current capture management algorithms, limits remote monitoring for CSP patients. CONCLUSIONS This survey provides a snapshot of CSP implementation in Europe. Currently, CSP is predominantly used for bradycardia indications. For HF patients with LBBB, most operators reserve CSP for biventricular implant failures. Left bundle branch area pacing ostensibly has practical advantages over HBP and is therefore preferred by many operators. Practical limitations remain, and large randomized clinical trial data are currently lacking.
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Affiliation(s)
- Daniel Keene
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
| | - Frédéric Anselme
- Department of Cardiology, Centre Hospitalier Universitaire de Rouen Charles Nicolle, Rouen, France
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Óscar Cano Pérez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Department of Cardiology, Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares, Madrid, Spain
| | - Karol Čurila
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Michael Derndorfer
- Department of Internal Medicine 2 with Cardiology, Angiology and Intensive Care, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Paul Foley
- Wiltshire Cardiac Centre, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - László Gellér
- Semmelweis University, Cardiovascular Center, Budapest, Hungary
| | - Michael Glikson
- Department of Cardiology, Shaare Zedek Medical Center and Hebrew University faculty of medicine, Jerusalem, Israel
| | - Wim Huybrechts
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Marek Jastrzebski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | | | - Grigorios Katsouras
- Department of Cardiology, ‘F. Miulli’ Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Jonathan Lyne
- Cardiology Department, Beacon Hospital, Dublin, Ireland
| | - Pablo Peñafiel Verdú
- Arrhythmia Unit, Department of Cardiology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Christian Restle
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Sergio Richter
- Department of Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Stefan Timmer
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | - 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, Du Cane Road, London W12, UK
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16
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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: 1.0] [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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17
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Schiavone M, Arosio R, Valenza S, Ruggiero D, Mitacchione G, Lombardi L, Viecca M, Forleo GB. Cardiac resynchronization therapy: present and future. Eur Heart J Suppl 2023; 25:C227-C233. [PMID: 37125274 PMCID: PMC10132566 DOI: 10.1093/eurheartjsupp/suad046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Cardiac resynchronization therapy (CRT) via biventricular pacing (BVP) is a well-established therapy for patients with heart failure with reduced ejection fraction and left bundle branch block, who remain symptomatic despite optimal medical therapy. Despite the long-standing clinical evidence, as well as the familiarity of cardiac electrophysiologists with the implantation technique, CRT via BVP cannot be achieved or may result ineffective in up to one-third of the patients. Therefore, new alternative techniques, such as conduction system pacing and left ventricular pacing, are emerging as potential alternatives to this technique, not only in case of BVP failure, but also as a stand-alone first choice due to several potential advantages over traditional CRT. Specifically, due to its procedural characteristics, left bundle branch area pacing appears to be the most convincing technique, showing comparable efficacy outcomes when compared with traditional CRT, not increasing short-term device-related complications, as well as improving procedural times. However, transvenous leads remain a major limitation of all these pacing modalities. To overcome this limit, a leadless left ventricular endocardial pacing has been developed as an additional tool to achieve a left endocardial activation, although being still associated with non-negligible pitfalls, limiting its current use in clinical practice. This article focuses on the current state and latest progresses in cardiac resynchronization therapy.
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Affiliation(s)
- Marco Schiavone
- Cardiology Unit, Luigi Sacco University Hospital, Via G.B. Grassi 74, Milan 20157, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Arosio
- Cardiology Unit, Luigi Sacco University Hospital, Via G.B. Grassi 74, Milan 20157, Italy
| | - Simone Valenza
- Cardiology Unit, Luigi Sacco University Hospital, Via G.B. Grassi 74, Milan 20157, Italy
| | - Diego Ruggiero
- Cardiology Unit, Luigi Sacco University Hospital, Via G.B. Grassi 74, Milan 20157, Italy
| | - Gianfranco Mitacchione
- Cardiology Unit, Luigi Sacco University Hospital, Via G.B. Grassi 74, Milan 20157, Italy
| | - Leonida Lombardi
- Cardiology Unit, Luigi Sacco University Hospital, Via G.B. Grassi 74, Milan 20157, Italy
| | - Maurizio Viecca
- Cardiology Unit, Luigi Sacco University Hospital, Via G.B. Grassi 74, Milan 20157, Italy
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18
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Batul SA, Vijayaraman P. Intracardiac Echocardiography Guidance for Left Bundle Pacing: An Expensive Adjunct or Necessity for Optimal Lead Placement? Circ Arrhythm Electrophysiol 2023; 16:e011931. [PMID: 36951088 PMCID: PMC10473020 DOI: 10.1161/circep.123.011931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Affiliation(s)
- Syeda Atiqa Batul
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, PA
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19
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Rademakers LM, van den Broek JLPM, Bracke FA. Left bundle branch pacing as an alternative to biventricular pacing for cardiac resynchronisation therapy. Neth Heart J 2023; 31:140-149. [PMID: 35920989 PMCID: PMC10033770 DOI: 10.1007/s12471-022-01712-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Left bundle branch pacing (LBBP) is a novel physiological pacing technique which may serve as an alternative to biventricular pacing (BVP) for the delivery of cardiac resynchronisation therapy (CRT). This study assessed the feasibility and outcomes of LBBP in comparison to BVP. METHODS LBBP was attempted in 40 consecutive patients as the first-line method for delivering CRT. To evaluate LBBP versus BVP, 40 patients with identical inclusion criteria who received BVP were compared with the LBBP group. Acute success rate, complications, functional and echocardiographic outcomes as well as hospitalisation for heart failure and all-cause mortality 6 months after implantation were evaluated. RESULTS LBBP was successfully performed in 31 (78%) patients and resulted in significant QRS narrowing (from 166 ± 16 to 123 ± 18 ms, p < 0.001), improvement in left ventricular ejection fraction (LVEF; from 28 ± 8 to 43 ± 12%, p < 0.001) and New York Heart Association functional class (from 2.8 ± 0.5 to 1.6 ± 0.6, p < 0.001) at 6 months. No LBBP-related complications occurred. Compared to BVP, LBBP resulted in a greater reduction in QRS duration (44 ± 17 vs 15 ± 26 ms, p < 0.001) with comparable absolute improvement in LVEF (15.2 ± 11.7 vs 9.6 ± 12.1%, p = 0.088). Hospitalisation for heart failure and all-cause mortality were similar in the two groups. CONCLUSIONS LBBP is feasible and was safe in 78% of patients with favourable electrical resynchronisation and functional improvement and may serve as an alternative to BVP.
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Affiliation(s)
- L M Rademakers
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
| | | | - F A Bracke
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
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20
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Approach to Left Bundle Branch Pacing. Cardiol Rev 2023:00045415-990000000-00084. [PMID: 36912509 DOI: 10.1097/crd.0000000000000545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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21
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Hu Y, Cheng S, He P, Huang H, Li H, Weng S, Sun XR, Gu M, Niu H, Liu X, Jin H, Zhou X, Hua W. A novel approach for developing left bundle branch pacing and left bundle branch block in a canine model. J Cardiovasc Electrophysiol 2023; 34:997-1005. [PMID: 36758949 DOI: 10.1111/jce.15854] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Left bundle branch pacing (LBBP) has shown the benefits in the treatment of dyssynchronous heart failure (HF). The purpose of this study was to develop a novel approach for LBBP and left bundle branch block (LBBB) in a canine model. METHODS A "triangle-center" method by tricuspid valve annulus angiography for LBBP implantation was performed in 6 canines. A catheter was then applied for retrograde His potential recording and left bundle branch (LBB) ablation simultaneously. The conduction system was stained to verify the "triangle-center" method for LBBP and assess the locations of the LBB ablation site in relation to the left septal fascicle (LSF). RESULTS The mean LBB potential to ventricular interval and stimulus-peak left ventricular activation time were 11.8 ± 1.2 and 35.7 ± 3.1 ms, respectively. The average intrinsic QRS duration was 44.7 ± 4.7 ms. LBB ablation significantly prolonged the QRS duration (106.3 ± 8.3 ms, p < .001) while LBBP significantly shortened the LBBB-QRS duration to 62.5 ± 5.3 ms (p < .001). After 6 weeks of follow-up, both paced QRS duration (63.0 ± 5.4 ms; p = .203) and LBBB-QRS duration (107.3 ± 7.4 ms; p = .144) were unchanged when comparing to the acute phase, respectively. Anatomical analysis of 6 canine hearts showed that the LBBP lead-tip was all placed in LSF area. CONCLUSION The new approach for LBBP and LBBB canine model was stable and feasible to simulate the clinical dyssynchrony and resynchronization. It provided a useful tool to investigate the basic mechanisms of underlying physiological pacing benefits.
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Affiliation(s)
- Yiran Hu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Sijing Cheng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pengkang He
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Hao Huang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Li
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sixian Weng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue Rong Sun
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Gu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongxia Niu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi Liu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Jin
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Xiaohong Zhou
- Department of Cardiology, Cardiac Rhythm Management, Medtronic plc, Mounds View, Minnesota, USA
| | - Wei Hua
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
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Bressi E, Grieco D, Luermans J, Burri H, Vernooy K. Conduction system pacing for cardiac resynchronization therapy: State of the art, current controversies, and future perspectives. Front Physiol 2023; 14:1124195. [PMID: 36711020 PMCID: PMC9880410 DOI: 10.3389/fphys.2023.1124195] [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: 12/14/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023] Open
Abstract
Biventricular pacing (BVP) is the established treatment to perform cardiac resynchronization therapy (CRT) in patients with heart failure (HF) and left bundle branch block (LBBB). However, BVP is an unnatural pacing modality still conditioned by the high percentage of non-responders and coronary sinus anatomy. Conduction system pacing (CSP)-His bundle pacing (HBP) and Left bundle branch area pacing (LBBAP)- upcomes as the physiological alternative to BVP in the quest for the optimal CRT. CSP showed promising results in terms of better electro-mechanical ventricular synchronization compared to BVP. However, only a few randomized control trials are currently available, and technical challenges, along with the lack of information on long-term clinical outcomes, limit the establishment of a primary role for CSP over conventional BVP in CRT candidates. This review provides a comprehensive literature revision of potential applications of CSP for CRT in diverse clinical scenarios, underlining the current controversies and prospects of this technique.
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Affiliation(s)
- Edoardo Bressi
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands,Department of Cardiovascular Sciences, Policlinico Casilino of Rome, Rome, Italy,*Correspondence: Edoardo Bressi,
| | - Domenico Grieco
- Department of Cardiovascular Sciences, Policlinico Casilino of Rome, Rome, Italy
| | - Justin Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
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24
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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: 8] [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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25
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Mirolo A, Chaumont C, Auquier N, Savoure A, Godin B, Vandevelde F, Eltchaninoff H, Anselme F. Left bundle branch area pacing in patients with baseline narrow, left, or right bundle branch block QRS patterns: insights into electrocardiographic and echocardiographic features. Europace 2022; 25:526-535. [PMID: 36480437 PMCID: PMC9935006 DOI: 10.1093/europace/euac223] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
AIMS Left bundle branch area pacing (LBBAP) is a recent technique aiming at preservation of physiological ventricular electrical activation. Our goal was to assess mechanical synchrony parameters in relation to electrocardiographic features during LBBAP performed in routine practice. METHODS AND RESULTS From June 2020 to August 2021, all patients of our institution with permanent pacemaker implantation indication were eligible for LBBAP. A 'qR' pattern in V1 and a delay from pacing spike to the peak of the R-wave in V6 < 80 ms defined a successful LBBAP. Electrocardiogram and echocardiography were performed during spontaneous rhythm and LBBAP: left ventricular mechanical synchrony (LVMS) parameters using 2D Speckle tracking and interventricular mechanical delay (IVMD) were collected. LBBAP was attempted with success in 134/163 patients (82.2%). During LBBAP, the mean QRS width was 104 ± 12 ms. In patients with left bundle branch block (n = 47), LBBAP provided a significant decrease of QRS width from 139 ± 16 to 105 ± 12 ms (P < 0.001) with reduction of LVMS (53 ± 21 vs. 90 ± 46 ms, P = 0.009), and IVMD (14 ± 13 vs. 49 ± 18 ms, P < 0.001). In patients with right bundle branch block (n = 38), LBBAP led to a significant decrease of QRS width from 134 ± 14 to 106 ± 13 ms (P < 0.001) with no effect on LVMS and a reduction of IVMD (17 ± 14 vs. 50 ± 16 ms, P < 0.001). CONCLUSION LBBAP in routine practice preserved intra-ventricular mechanical synchrony in patients with narrow and RBBB QRS and improved asynchrony parameters in patients with LBBB.
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Affiliation(s)
- Adrian Mirolo
- Department of cardiology, Rouen University Hospital, CHU—Hôpitaux de Rouen, 1 rue de Germont, 76031 Rouen, France
| | - Corentin Chaumont
- Department of cardiology, Rouen University Hospital, CHU—Hôpitaux de Rouen, 1 rue de Germont, 76031 Rouen, France
| | - Nathanael Auquier
- Department of cardiology, Jacques Monod Hospital, 29 Av. Pierre Mendès France, 76290 Montivilliers, France
| | - Arnaud Savoure
- Department of cardiology, Rouen University Hospital, CHU—Hôpitaux de Rouen, 1 rue de Germont, 76031 Rouen, France
| | - Benedicte Godin
- Department of cardiology, Rouen University Hospital, CHU—Hôpitaux de Rouen, 1 rue de Germont, 76031 Rouen, France
| | - Florence Vandevelde
- Department of cardiology, Jacques Monod Hospital, 29 Av. Pierre Mendès France, 76290 Montivilliers, France
| | - Helene Eltchaninoff
- Department of cardiology, Rouen University Hospital, CHU—Hôpitaux de Rouen, 1 rue de Germont, 76031 Rouen, France
| | - Frederic Anselme
- Corresponding author. Tel: +33 2 32 88 81 11; Fax: +33 2 32 88 81 23. E-mail address:
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26
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Fu Y, Liu P, Jin L, Li Y, Zhang Y, Qin X, Zheng Q. Left bundle branch area pacing: A promising modality for cardiac resynchronization therapy. Front Cardiovasc Med 2022; 9:901046. [PMID: 36465440 PMCID: PMC9715961 DOI: 10.3389/fcvm.2022.901046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/31/2022] [Indexed: 12/19/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) is recognized as the first-line management for patients with heart failure (HF) and conduction disorders. As a conventional mode for delivering CRT, biventricular pacing (BVP) improves cardiac function and reduces HF hospitalizations and mortality, but there are still limitations given the high incidence of a lack of response rates. Alternative pacing methods are needed either for primary or rescue therapy. In recent years, conduction system pacing (CSP) has emerged as a more physiological pacing modality for simultaneous stimulation of the ventricles, including His bundle pacing (HBP) and left bundle branch pacing (LBBP). CSP activates the His-Purkinje system, allowing normal ventricular stimulation. However, HBP is technically challenging with a relatively low success rate, high pacing threshold, and failure to correct distal conduction abnormalities. Therefore, LBBP stands out as a novel ideal physiological pacing modality for CRT. Several non-randomized studies compared the feasibility and safety of LBBP with BVP and concluded that LBBP is superior to BVP for delivering CRT with a narrower QRS and greater improvements in left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) functional class. Concurrently, some studies showed lower and stable pacing thresholds and greater improvement of B-type natriuretic peptide (BNP) levels, as well as better mechanical synchronization and efficiency. LBBP ensures better ventricular electromechanical resynchronization than BVP. In this review, we discuss current knowledge of LBBP, compare LBBP with BVP, and explore the potential of LBBP to serve as an alternative primary therapy to realize cardiac resynchronization.
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Affiliation(s)
- Yuping Fu
- Department of Cardiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Peng Liu
- Department of Cardiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Lingyan Jin
- Department of Cardiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yingqi Li
- Department of Cardiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yudi Zhang
- Department of Cardiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xinghua Qin
- School of Life Sciences, Northwestern Polytechnical University, Xi’an, Shaanxi, China
| | - Qiangsun Zheng
- Department of Cardiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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27
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Meng Q, Li Y, Wang S, Feng T, Xu H, Liu J, Liu X, Guo Z, Deng Y, Li C, Tang Y, Yin L. Speckle tracking imaging evaluation of left ventricular myocardial work comparing right ventricular septal pacing with His-Purkinje system area pacing. Front Cardiovasc Med 2022; 9:949841. [PMID: 36386349 PMCID: PMC9640554 DOI: 10.3389/fcvm.2022.949841] [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: 05/21/2022] [Accepted: 10/04/2022] [Indexed: 11/21/2022] Open
Abstract
Aims We sought to objectively assess left ventricular myocardial work (MW) parameters after right ventricular septal pacing (VSP) and His-Purkinje system area pacing (HPSAP) procedures. Materials and methods Patients undergoing double-chamber pacemaker implantation for III-degree atrioventricular block (III° AVB) were assessed 1 year after implantation. VSP and HPSAP groups (20 and 23 patients, respectively) were compared against 40 healthy age-matched volunteers. Two-dimensional ultrasound speckle tracking imaging was used to obtain the global myocardial work index (GWI), global myocardial work efficiency (GWE), global myocardial constructive work (GCW), global myocardial wasted work (GWW), left ventricular stratified strain, and peak strain dispersion (PSD). Results GWI, GWE, and GCW parameters were improved in HPSAP compared to VSP, while GWW was significantly larger in the VSP group compared to the HPSAP group (all p < 0.05). HPSAP outperformed the VSP group in comparisons of global left ventricular longitudinal strain and stratified strain. Compared to controls, the GCW of all segmental myocardium (17/17 segments) in the VSP group was significantly reduced, while 70.59% (12/17 segments) in the HPSAP group was lower than the control group. GCW in the left ventricular segment of the HPSAP group was bigger than the VSP group (29.41%; 5/17 segments) and mainly concentrated in the ventricular septum and inferior wall. Conclusion Our findings suggest that HPSAP performance outcomes are improved over VSP after 1 year, especially in left ventricular contractile synchrony, and HPSAP is beneficial to the effective myocardial work of the left ventricle.
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Affiliation(s)
- Qingguo Meng
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yao Li
- Department of Cardiac Function, Chengdu First People’s Hospital, Chengdu, China
| | - Sijia Wang
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Tianhang Feng
- Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Huijun Xu
- Department of Gerontology, Xiqing Hospital, Tianjin, China
| | - Juan Liu
- Chengdu Women’s and Children’s Central Hospital, Chengdu, China
| | - Xuebing Liu
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhiyu Guo
- Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yan Deng
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chunmei Li
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yijia Tang
- Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Lixue Yin
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
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28
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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: 186] [Impact Index Per Article: 93.0] [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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29
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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: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [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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30
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Li W, Ding Y, Gong C, Zhou G, Lu X, Wei Y, Peng S, Cai L, Yuan T, Li F, Liu S, Chen S. Comparisons of electrophysiological characteristics, pacing parameters and mid- to long-term effects in right ventricular septal pacing, right ventricular apical pacing and left bundle branch area pacing. BMC Cardiovasc Disord 2022; 22:417. [PMID: 36123615 PMCID: PMC9484219 DOI: 10.1186/s12872-022-02855-8] [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: 03/07/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background As a near-physiological pacing innovation, left bundle branch area pacing (LBBAP) has drawn much attention recently. This study was aimed to investigate the electrophysiological characteristics, unipolar/bipolar pacing parameters and mid- to long-term effects and safety of three different pacing methods and identify possible predictors of adverse left ventricular remodeling.
Methods Ninety-two patients were divided into the LBBAP group, right ventricular septal pacing (RVSP) group and right ventricular apical pacing (RVAP) group. Baseline information, electrophysiological, pacing and echocardiographic parameters were collected. Results The three pacing methods were performed with a similar high success rate. The paced QRSd was significantly different among the LBBAP, RVSP and RVAP groups (105.93 ± 15.85 ms vs. 143.63 ± 14.71 ms vs. 155.39 ± 14.17 ms, p < 0.01). The stimulus to left ventricular activation time (Sti-LVAT) was the shortest in the LBBAP group, followed by the RVSP and RVAP groups (72.80 ± 12.07 ms vs. 86.29 ± 8.71 ms vs. 94.14 ± 10.14 ms, p < 0.001). LBBAP had a significantly lower tip impedance during the procedure and 3-month follow up as compared to RVSP and RVAP (p < 0.001). Higher bipolar captured thresholds were observed in LBBAP during the procedure (p < 0.001). Compared to the baseline values, there was a greater reduction in left ventricular end-diastolic dimension (LVEDD) in the LBBAP group (p = 0.046) and a significant enlargement in LVEDD in the RVAP group (p = 0.008). Multiple regression analysis revealed that the Sti-LVAT was a significant predictor of LVEDD at 12 months post-procedure. At the 24-h post-procedure, significant elevations were observed in the cTnI levels in LBBAP (p < 0.001) and RVSP (p < 0.05). More transient RBB injury was observed in LBBAP. But no significant difference was found in cardiac composite endpoints among three groups (p > 0.05). Conclusions LBBAP demonstrated a stable captured threshold, a low tip impedance and a high R-wave amplitude during the 12-month follow-up. Left ventricular remodeling was improved at 12 months post-procedure through LBBAP. The Sti-LVAT was a significant predictor of left ventricular remodeling. LBBAP demonstrated its feasibility, effectiveness, safety and some beneficial electrophysiological characteristics during this mid- to long-term follow-up, which should be confirmed by further studies.
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Affiliation(s)
- Wenhua Li
- Department of Cardiology, Shanghai General Hospital of Nanjing Medical University, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China.,Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou City, Jiangsu Province, China
| | - Yu Ding
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Gong
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Genqing Zhou
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Lu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Wei
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shi Peng
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lidong Cai
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianyou Yuan
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fangfang Li
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaowen Liu
- Department of Cardiology, Shanghai General Hospital of Nanjing Medical University, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China. .,Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Songwen Chen
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Li Q, Dai W, Fang D, Ma W, Lin C, Lu C, He D, Liu X, Guo C. Occurrence of ventricular septal perforation in patients with permanent left bundle branch pacing followed up using echocardiographic and computed tomography images. Ann Noninvasive Electrocardiol 2022; 27:e13002. [PMID: 36087037 DOI: 10.1111/anec.13002] [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: 05/18/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To explore short-term changes after left bundle branch pacing (LBBP) using echocardiography and computed tomography (CT), especially for postoperative ventricular septal perforation. METHODS Between January and September 2019, 33 patients with atrioventricular block underwent LBBP at Beijing Anzhen Hospital. All the patients were evaluated using electrocardiography, pacing, parameters and echocardiographic measurements, including for major complications, during the 1, 3, 6, 12 and 24-month follow-up. Interval perforations were examined during a 1-month follow-up echocardiogram and CT. RESULTS Left bundle branch pacing was successfully performed in 100% (33/33) of patients. The mean seizure threshold was stable and unchanged postoperatively at the 1, 3, 6, 12 and 24-month follow-up. The paced QRS duration of the LBBP was 119.72 ± 2.53 ms and <130 ms in all patients. Unipolar impedance during the procedure was higher than 500 Ω (662.00 ± 181.50 Ω). No ventricular septal perforation occurred at the end of the procedure. At the 1-month follow-up, two patients reported transthoracic echocardiography, with CT revealing septal lead perforation. Through CT, two other patients were found to have septal lead perforation, and echocardiography indicated that the pacing lead had penetrated the interventricular septum and entered the left subendocardium. At the 1, 3, 6, 12 and 24-month follow-up, these four patients exhibited no significant increase in pacing threshold or impedance (p > .05). No ventricular thrombus or stroke was detected. CONCLUSION Permanent LBBP is safe and feasible in patients with bradycardia. Echocardiography and/or CT can more accurately evaluate changes in cardiac structure and function after LBBP.
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Affiliation(s)
- Qiaoyuan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wenlong Dai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dongping Fang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Weili Ma
- Department of Cardiology, Chaoyang Central Hospital, Chaoyang, China
| | - Cancan Lin
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chunshan Lu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dongfang He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chengjun Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 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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Feng XF, Yang LC, Zhao Y, Yu YC, Liu B, Li YG. Effects of adaptive left bundle branch-optimized cardiac resynchronization therapy: a single centre experience. BMC Cardiovasc Disord 2022; 22:360. [PMID: 35933334 PMCID: PMC9357303 DOI: 10.1186/s12872-022-02742-2] [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: 03/26/2022] [Accepted: 06/30/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Adaptive cardiac resynchronization therapy (aCRT) is associated with improved clinical outcomes. Left bundle branch area pacing (LBBAP) has shown encouraging results as an alternative option for aCRT. A technique that can be accomplished effectively using LBBAP combined with coronary venous pacing (LOT-aCRT). We aimed to assess the feasibility and outcomes of LOT-aCRT. METHODS LOT-aCRT, capable of providing two pacing modes, LBBAP alone or LBBAP combined with LV pacing, was attempted in patients with CRT indications. Patients were divided into two groups: those with LBBAP and LV pacing (LOT-aCRT) and those with conventional biventricular pacing (BVP-aCRT). RESULTS A total of 21 patients were enrolled in the study (10 in the LOT-aCRT group, 11 in the BVP-aCRT group). In the LOT-aCRT group, the QRS duration (QRSd) via BVP was narrowed from 158.0 ± 13.0 ms at baseline to 132.0 ± 4.5 ms (P = 0.019) during the procedure, and further narrowed to 123.0 ± 5.7 ms (P < 0.01) via LBBAP. After the procedure, when LOT-aCRT implanted and worked, QRSd was further changed to 121.0 ± 3.8 ms, but the change was not significant (P > 0.05). In the BVP-aCRT group, BVP resulted in a significant reduction in the QRSd from 176.7 ± 19.7 ms at baseline to 133.3 ± 8.2 ms (P = 0.011). However, compared with LOT-aCRT, BVP has no advantage in reducing QRSd and the difference was statistically significant (P < 0.01). During 9 months of follow-up, patients in both groups showed improvements in the LVEF and NT-proBNP levels (all P < 0.01). However, compared with BVP-aCRT, LOT-aCRT showed more significant changes in these parameters (P < 0.01). CONCLUSIONS The study demonstrates that LOT-aCRT is clinically feasible in patients with systolic heart failure and LBBB. LOT-aCRT was associated with significant narrowing of the QRSd and improvement in LV function.
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Affiliation(s)
- Xiang-Fei Feng
- grid.16821.3c0000 0004 0368 8293Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, #1665, KongJiang Road, Shanghai, 200092 China
| | - Ling-Chao Yang
- grid.16821.3c0000 0004 0368 8293Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, #1665, KongJiang Road, Shanghai, 200092 China
| | - Yan Zhao
- grid.16821.3c0000 0004 0368 8293Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, #1665, KongJiang Road, Shanghai, 200092 China
| | - Yi-Chi Yu
- grid.16821.3c0000 0004 0368 8293Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, #1665, KongJiang Road, Shanghai, 200092 China
| | - Bo Liu
- grid.16821.3c0000 0004 0368 8293Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, #1665, KongJiang Road, Shanghai, 200092 China
| | - Yi-Gang Li
- grid.16821.3c0000 0004 0368 8293Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, #1665, KongJiang Road, Shanghai, 200092 China
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Rijks J, Luermans J, Heckman L, van Stipdonk AMW, Prinzen F, Lumens J, Vernooy K. Physiology of Left Ventricular Septal Pacing and Left Bundle Branch Pacing. Card Electrophysiol Clin 2022; 14:181-189. [PMID: 35715076 DOI: 10.1016/j.ccep.2021.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Following the recognition of the adverse effects of right ventricular pacing, alternative permanent pacing strategies aiming to maintain a synchronous ventricular contraction have been sought. The quest for the optimal pacing site has recently led to several promising and rapidly emerging new pacing strategies, such as left ventricular septal pacing and left bundle branch pacing. In both animal and human studies, these pacing strategies seem to maintain electrical and mechanical activation of the left ventricle to a (near)physiologic level. However, more studies on the long-term effects of both strategies are needed.
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Affiliation(s)
- Jesse Rijks
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 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
| | - Luuk Heckman
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Antonius M W van Stipdonk
- 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
| | - Joost Lumens
- Department of Biomedical Engineering, 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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Herweg B, Welter-Frost A, Wilson Ii DR, Vijayaraman P. Conduction System Pacing for Cardiac Resynchronization Therapy. Card Electrophysiol Clin 2022; 14:297-310. [PMID: 35715087 DOI: 10.1016/j.ccep.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Although conventional biventricular pacing has been shown to benefit patients with heart failure and conduction system disease, there are limitations to its therapeutic success, resulting in widely variable clinical response. Limitations of conventional biventricular pacing evolve around myocardial scar, fibrosis, and inability to effectively stimulate diseased tissue. Several observational and acute hemodynamic studies have demonstrated improved electrical resynchronization and echocardiographic response with conduction system pacing. This article provides a systematic review of conduction system pacing as a physiologic alternative to conventional CRT, which is currently undergoing rigorous investigation.
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Affiliation(s)
- Bengt Herweg
- Department of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, South Tampa Center (3rd Floor), Tampa, FL 33606, USA; Tampa General Hospital, 1 Tampa General Circle, Tampa, FL 33606, USA.
| | - Allan Welter-Frost
- Department of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, South Tampa Center (3rd Floor), Tampa, FL 33606, USA; Tampa General Hospital, 1 Tampa General Circle, Tampa, FL 33606, USA
| | - David R Wilson Ii
- Department of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, South Tampa Center (3rd Floor), Tampa, FL 33606, USA; Tampa General Hospital, 1 Tampa General Circle, Tampa, FL 33606, USA
| | - Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, 1000 E. Mountain Blvd, Wilkes-Barre, PA 18711, USA
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De Pooter J, Ozpak E, Calle S, Peytchev P, Heggermont W, Marchandise S, Provenier F, Francois B, Anné W, Pollet P, Barbraud C, Gillis K, Timmermans F, Van Heuverswyn F, Tung R, Wauters A, le Polain de Waroux J. Initial experience of left bundle branch area pacing using stylet‐driven pacing leads: a multicenter study. J Cardiovasc Electrophysiol 2022; 33:1540-1549. [DOI: 10.1111/jce.15558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Emine Ozpak
- Heart CenterUniversity Hospital GhentBelgium
| | - Simon Calle
- Heart CenterUniversity Hospital GhentBelgium
| | | | | | - Sebastien Marchandise
- Institut Cardiovasculaire, Cliniques Universitaire Saint‐Luc, UCL LouvainBruxellesBelgium
| | | | | | - Wim Anné
- Dienst Cardiologie AZ DeltaRoeselareBelgium
| | | | - Cynthia Barbraud
- Service Cardiologie, Citadelle Château RougeSainte RosalieLiègeBelgium
| | | | | | | | - Roderick Tung
- Division of Cardiology, The University of Arizona College of Medicine‐PhoenixArizona
| | - Aurélien Wauters
- Institut Cardiovasculaire, Cliniques Universitaire Saint‐Luc, UCL LouvainBruxellesBelgium
- Service de Cardiologie, Clinique Saint PierreOttigniesBelgium
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Chen X, Zhou X, Wang Y, Jin Q, Chen Y, Wang J, Qin S, Bai J, Wang W, Liang Y, Chen H, Su Y, Ge J. Evaluation of electrophysiological characteristics and ventricular synchrony: An intrapatient-controlled study during His-Purkinje conduction system pacing versus right ventricular pacing. Clin Cardiol 2022; 45:723-732. [PMID: 35502628 PMCID: PMC9286324 DOI: 10.1002/clc.23837] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 12/17/2022] Open
Abstract
Objectives to Background To compare electromechanical ventricular synchrony when pacing from different sites, including right ventricular apex pacing (RVAP), right ventricular septum pacing (RVSP), His bundle pacing (HBP), left bundle branch pacing (LBBP), and RVSP during unipolar pacing from the ring electrode of LBBP lead (RVSPring) in each patient and evaluate the correlations between electrophysiological characteristics and ventricular synchrony. Methods Twenty patients with complete atrioventricular block indicated for dual‐chamber pacemaker implantation were included in the study. Unipolar pacing at different sites, including RVAP, RVSP, HBP, LBBP, and RVSPring, was successively performed in each patient. The pacing characteristics and echocardiogram parameters were collected and compared among intrinsic rhythm and pacing at different sites. Results Similar to HBP (114.84 ± 18.67 ms), narrower paced QRSd was found in LBBP (116.15 ± 11.60 ms) as compared to RVSPring (135.11 ± 13.68 ms), RVSP (141.65 ± 14.26 ms), and RVAP (160.15 ± 19.35 ms) (p < .001). LBBP showed comparable pacing parameters to RVAP or RVSP and was significantly better than HBP, with maintained cardiac function. TS‐12‐SD was significantly improved in LBBP (41.80 ± 20.97 ms) than RVAP (69.70 ± 32.42 ms, p = .003) and RVSP (63.30.56 ± 32.53 ms, p = .018) but similar to HBP (51.50 ± 25.67 ms, p = .283) or RVSPring (57.80 ± 25.65 ms, p = .198). Among these pacing strategies, negative values of interventricular mechanical delay (IVMD) were only identified in LBBP (−19.25 ± 18.43 ms), significantly different from RVAP (35.00 ± 30.72 ms), RVSP (22.85 ± 22.05 ms), HBP (5.20 ± 18.64 ms), and RVSPring (16.00 ± 26.76 ms (all p < .05). Using Pearson's analysis, Sti‐LVAT was positively correlated with QRS duration, IVMD, TS‐12‐SD, LVEDV, and LVESV, while a negative relationship could be observed for left ventricular ejection fraction. Conclusions His‐Purkinje conduction system pacing (HPCSP) achieved better electrical and mechanical synchrony than conventional RV pacing. For interventricular synchrony, only LBBP initiated earlier LV activation than RV, in accordance with the right bundle branch block (RBBB) pattern of paced QRS during LBBP. Sti‐LVAT might be a good parameter correlating with LV systolic function and mechanical synchrony.
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Affiliation(s)
- Xueying Chen
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Xiaolan Zhou
- Huashan Worldwide Medical Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanan Wang
- Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qinchun Jin
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yufei Chen
- Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingfeng Wang
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Shengmei Qin
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Jin Bai
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Wei Wang
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yixiu Liang
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Haiyan Chen
- Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yangang Su
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
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Zhou Y, Wang J, Wei Y, Zhang W, Yang Y, Rui S, Ju C. Left ventricular septal pacing versus left bundle branch pacing in the treatment of atrioventricular block. Ann Noninvasive Electrocardiol 2022; 27:e12944. [PMID: 35267228 PMCID: PMC9107083 DOI: 10.1111/anec.12944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the feasibility and clinical response of LVSP as an alternative to LBBP. METHODS This was a retrospective study of pacemaker implantation, and 46 consecutive patients with pacemaker implantation were enrolled in the study. The patients were divided into the LBBP and LVSP groups. Electrocardiogram characteristics, pacing parameters, cardiac function, and safety events were assessed during implantation and 12-month follow-up. RESULTS The procedure time was significantly increased in the LBBP group compared with the LVSP group (53.52 ± 14.39 min vs. 38.13 ± 11.52 min, respectively, p = .000). The pacing QRS duration (PQRSD) decreased by 14.09 ± 41.80 ms in the LBBP group and increased by 9.70 ± 29.60 ms in the LVSP group (p = .031). Furthermore, the left ventricle activation time (LVAT) was shorter in the LBBP group than in the LVSP group (48.70 ± 13.67 ms vs. 58.70 ± 13.67 ms, p = .032). During the 12-month follow-up, pacing thresholds remained low and stable, and there was no significant decrease in cardiac function. No adverse event was observed during the follow-up period. CONCLUSIONS Both LBBP and LVSP are safe and feasible methods. LVSP is a good option when multichannel electrophysiological instruments are not available and when the time available for the procedure is limited.
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Affiliation(s)
- Yu Zhou
- Department of EmergencyThe First Affiliated Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Jinfeng Wang
- Department of CardiologyThe First Affiliated Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Youquan Wei
- Department of CardiologyThe First Affiliated Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Wenbo Zhang
- Department of CardiologyThe First Affiliated Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Yuwen Yang
- Department of CardiologyThe First Affiliated Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Shibao Rui
- Department of CardiologyThe First Affiliated Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Changlin Ju
- Department of CardiologyThe First Affiliated Hospital of Wannan Medical CollegeWuhuAnhuiChina
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Chen K, Liu XB, Hou X, Qiu Y, Lin J, Dai Y, Xu YN, Jiang LY, Zhou X, Zhang X, Lu H, Mara N, Demmer W, Cheng A, Zou J. Computed tomography imaging-identified location and electrocardiographic characteristics of left bundle branch area pacing in bradycardia patients. J Cardiovasc Electrophysiol 2022; 33:1244-1254. [PMID: 35419908 DOI: 10.1111/jce.15493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/12/2022] [Accepted: 04/09/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Left bundle branch area pacing (LBBAP) is a novel physiological pacing modality. The relationship between the pacing lead tip location and paced electrocardiographic (ECG) characteristics remains unclear. The objectives are to determine the lead tip location within the interventricular septum (IVS) and assess the location-based ECG QRS duration (QRSd) and left ventricular activation time (LVAT). METHODS This multi-center study enrolled 50 consecutive bradycardia patients who met pacemaker therapy guidelines and received LBBAP implantation via the trans-ventricular septal approach. After at least 3 months post implant, 12-lead ECGs and pacing parameters were obtained. Cardiac computed tomography (CT) imaging was performed to assess the LBBAP lead tip distance from the LV blood pool. RESULTS Among the 50 patients, analyzable CT images were obtained in 42. In 23 of the 42 patients, the lead tips were within 2 mm to the LV blood pool (the LV subendocardial (LVSE) group), 13 between 2 mm and 4 mm (the Near-LVSE group), and the remaining 6 beyond 4 mm (the mid-LV septal (Mid-LVS) group). No significant differences in paced QRSd were found among the 3 groups (LVSE, 107±15 ms; Near-LVSE, 106±13 ms; Mid-LVS, 104±15 ms; P=0.87). LVAT in the LVSE (64±7 ms) was significantly shorter than in the Mid-LVS (72±8 ms; P<0.05), but not significantly different from that in the Near-LVSE (69±8 ms; P>0.05). CONCLUSION In routine LBBAP practice, paced narrow QRSd and fast LVAT, indicative of physiological pacing, was consistently achieved for lead tip location in the LV subendocardial or near LV subendocardial region. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Keping Chen
- Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xing-Bin Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofeng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuanhao Qiu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jinxuan Lin
- Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Dai
- Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan-Ning Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling-Yun Jiang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaohong Zhou
- Cardiac Rhythm Management, Medtronic plc., Mounds View, MN, USA
| | - Xue Zhang
- Cardiac Rhythm Management, Medtronic Technology Center, Medtronic (Shanghai) Ltd., Shanghai, China
| | - Hongyang Lu
- Cardiac Rhythm Management, Medtronic Technology Center, Medtronic (Shanghai) Ltd., Shanghai, China
| | - Nicki Mara
- Cardiac Rhythm Management, Medtronic plc., Mounds View, MN, USA
| | - Wade Demmer
- Cardiac Rhythm Management, Medtronic plc., Mounds View, MN, USA
| | - Alan Cheng
- Cardiac Rhythm Management, Medtronic plc., Mounds View, MN, USA
| | - Jiangang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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41
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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: 1.0] [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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42
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Wu S, Zhou X, Huang W. Physiological pacing with conduction system capture: How to confirm bundle capture in clinical practice. J Cardiovasc Electrophysiol 2022; 33:1332-1335. [PMID: 35352429 DOI: 10.1111/jce.15477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Abstract
As the main components of physiological pacing, conduction system pacing has been demonstrated its feasibility, safety and favorable clinical outcomes This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shengjie Wu
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaohong Zhou
- Cardiac Rhythm Management, Medtronic, plc, Minneapolis, Minnesota
| | - Weijian Huang
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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43
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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: 0.5] [Reference Citation Analysis] [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
- *Correspondence: Dong Chang
| | - Qiang Li
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Qiang Li
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44
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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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45
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De Pooter J, Wauters A, Van Heuverswyn F, Le polain de Waroux JB. A Guide to Left Bundle Branch Area Pacing Using Stylet-Driven Pacing Leads. Front Cardiovasc Med 2022; 9:844152. [PMID: 35265691 PMCID: PMC8899462 DOI: 10.3389/fcvm.2022.844152] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Left bundle branch area pacing (LBBAP) has emerged as a novel pacing modality which aims to capture the left bundle branch area and avoids the detrimental effects of right ventricular pacing. Current approaches for LBBAP have been developed using lumen-less pacing leads (LLL). Expanding the tools and leads for LBBAP might contribute to a wider adoption of this technique. Standard stylet-driven pacing leads (SDL) differ from current LLL as they are characterized by a wider lead body diameter, are stylet-supported and often have a non-isodiametric extendable helix design. Although LBBAP can be performed safely with SDL, the implant technique of LBBAP differs compared to LLL. In the current overview we describe in detail how different types of SDL can be used to target a deep septal position and provide a practical guide on how to achieve LBBAP using SDL.
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Affiliation(s)
- Jan De Pooter
- Heart Center, University Hospital Ghent, Ghent, Belgium
- *Correspondence: Jan De Pooter
| | - Aurelien Wauters
- Service de Cardiologie, Clinique Saint Pierre, Ottignies, Belgium
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46
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Burri H. Complications with left bundle branch area pacing. Heart Rhythm 2022; 19:735-736. [PMID: 35121117 DOI: 10.1016/j.hrthm.2022.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Haran Burri
- University Hospital of Geneva, Cardiology Department Rue Gabrielle Perret Gentil 4 1211 Geneva Switzerland
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47
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His-Purkinje Pacing: Yes, We Can Pace the His and Left Bundle, But Should We? JACC Clin Electrophysiol 2022; 8:86-87. [PMID: 35057981 DOI: 10.1016/j.jacep.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/19/2021] [Indexed: 11/24/2022]
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48
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Xie H, Chen X, Wang Y, Cheng Y, Zhao Y, Liu Y, Liu Y, Ge Z, Chen H, Shu X. Comparison of the Acute Effects of Different Pacing Sites on Cardiac Synchrony and Contraction Using Speckle-Tracking Echocardiography. Front Cardiovasc Med 2021; 8:758500. [PMID: 34859073 PMCID: PMC8631923 DOI: 10.3389/fcvm.2021.758500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Cardiac pacing in patients with bradyarrhythmia may employ variable pacing sites, which may have different effects on cardiac function. Left bundle branch pacing (LBBP) is a new physiological pacing modality, and the acute outcomes on cardiac mechanical synchrony during LBBP remain uncertain. We evaluated the acute effects of four pacing sites on cardiac synchrony and contraction using speckle-tracking echocardiography, and comparisons among four different pacing sites were rare. Methods: We enrolled 21 patients with atrioventricular block or sick sinus syndrome who each sequentially underwent acute pacing protocols, including right ventricular apical pacing (RVAP), right ventricular outflow tract pacing (RVOP), His bundle pacing (HBP), and left bundle branch pacing (LBBP). Electrocardiograms and echocardiograms were recorded at baseline and during pacing. The interventricular mechanical delay (IVMD), the standard deviation of the times to longitudinal peak strain during 17 segments (PSD), and the Yu index were used to evaluate ventricular mechanical synchrony. Layer-specific strain was computed using two-dimensional speckle tracking technique to provide in-depth details about ventricular synchrony and function. Results: Left ventricular ejection fraction (LVEF) and tricuspid annulus plane systolic excursion (TAPSE) were significantly decreased during RVAP and RVOP but were not significantly different during HBP and LBBP compared with baseline. RVAP and RVOP significantly prolonged QRS duration, whereas HBP and LBBP showed non-significant effects. IVMD and PSD were significantly increased during RVAP but were not significantly different during RVOP, HBP, or LBBP. LBBP resulted in a significant improvement in the IVMD and Yu index compared with RVAP. No significant differences in mechanical synchrony were found between HBP and LBBP. Conclusion: Among these pacing modalities, RVAP has a negative acute impact on cardiac synchrony and contraction. HBP and LBBP best preserve physiological cardiac synchrony and function.
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Affiliation(s)
- Huilin Xie
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Xueying Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Yanan Wang
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Yufei Cheng
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Yingjie Zhao
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Yang Liu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Yu Liu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Zhenyi Ge
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Haiyan Chen
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
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49
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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: 2] [Impact Index Per Article: 0.7] [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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50
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Tung R, Upadhyay GA. The Burden of Proof in Defining Conduction Pacing Criteria: Back to Fundamental Electrophysiology. JACC Clin Electrophysiol 2021; 7:1178-1181. [PMID: 34556287 DOI: 10.1016/j.jacep.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Roderick Tung
- University of Chicago Pritzker School of Medicine, Center for Arrhythmia Care at the University of Chicago Medicine, Chicago, Illinois, USA.
| | - Gaurav A Upadhyay
- University of Chicago Pritzker School of Medicine, Center for Arrhythmia Care at the University of Chicago Medicine, Chicago, Illinois, USA
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