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Yang Z, Liu Z. Response to "Clinical advantage and disadvantage of trans-thoracic echocardiography guidance during left bundle branch pacing": Addressing key aspects of our study. J Cardiovasc Electrophysiol 2024; 35:1318. [PMID: 38650535 DOI: 10.1111/jce.16277] [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] [Received: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Zhihan Yang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhimin Liu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Peigh G, Steinberg BA. Mechanisms for structural remodeling with left bundle branch area pacing: more than meets the eye. J Interv Card Electrophysiol 2024; 67:221-223. [PMID: 37713018 DOI: 10.1007/s10840-023-01638-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Graham Peigh
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Benjamin Adam Steinberg
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North Mario Capecchi Drive, 3 North, Salt Lake City, UT, 84112, USA.
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Zhu H, Li X, Wang Z, Liu Q, Chu B, Yao Y, Liu Z, Xie R, Fan X. New-onset atrial fibrillation following left bundle branch area pacing vs. right ventricular pacing: a two-centre prospective cohort study. Europace 2022; 25:121-129. [PMID: 35942552 PMCID: PMC9907530 DOI: 10.1093/europace/euac132] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/30/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS To investigate whether left bundle branch area pacing (LBBAP) can reduce the risk of new-onset atrial fibrillation (AF) compared with right ventricular pacing (RVP). METHODS AND RESULTS Patients with indications for dual-chamber pacemaker implant and no history of AF were prospectively enrolled if they underwent successful LBBAP or RVP. The primary endpoint was time to the first occurrence of AF detected by pacemaker programming or surface electrocardiogram. Follow-up at clinic visit was performed and multivariate Cox regression models were applied to evaluate the effect of LBBAP on new-onset AF. The final analysis included 527 patients (mean age 65.3 ± 12.6, male 47.3%), with 257 in the LBBAP and 270 in the RVP groups. During a mean follow-up of 11.1 months, LBBAP resulted in significantly lower incidence of new-onset AF (7.4 vs. 17.0%, P < 0.001) and AF burden (3.7 ± 1.9 vs. 9.3 ± 2.2%, P < 0.001) than RVP. After adjusting for confounding factors, LBBAP demonstrated a lower hazard ratio for new-onset AF compared with RVP {hazard ratio (HR) [95% confidence interval (CI)]: 0.278 (0.156, 0.496), P < 0.001}. A significant interaction existed between pacing modalities and the percentage of ventricular pacing (VP%) (P for interaction = 0.020). In patients with VP ≥ 20%, LBBAP was associated with decreased risk of new-onset AF compared with RVP [HR (95% CI): 0.199 (0.105, 0.378), P < 0.001]. The effect of pacing modalities was not pronounced in patients with VP < 20% [HR (95% CI): 0.751 (0.309, 1.823), P = 0.316]. CONCLUSION Left bundle branch area pacing demonstrated a reduced risk of new-onset AF compared with RVP. Patients with a high ventricular pacing burden might benefit from LBBAP.
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Affiliation(s)
| | | | - Zhao Wang
- Department of Cardiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical
College, No. 167, Beilishi Road, Xicheng District, Beijing
100037, China
| | - Qian Liu
- Department of Cardiology, The Second Hospital of Hebei Medical
University, Shijiazhuang, Hebei, China
| | - Bingqian Chu
- Department of Cardiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical
College, No. 167, Beilishi Road, Xicheng District, Beijing
100037, China
| | - Yan Yao
- Department of Cardiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical
College, No. 167, Beilishi Road, Xicheng District, Beijing
100037, China
| | - Zhimin Liu
- Department of Cardiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical
College, No. 167, Beilishi Road, Xicheng District, Beijing
100037, China
| | - Ruiqin Xie
- Corresponding authors. E-mail addresses:
(X.F.);
(R.X.)
| | - Xiaohan Fan
- Corresponding authors. E-mail addresses:
(X.F.);
(R.X.)
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Physiologic Pacing Targeting the His Bundle and Left Bundle Branch: a Review of the Literature. Curr Cardiol Rep 2022; 24:959-978. [PMID: 35678938 DOI: 10.1007/s11886-022-01723-3] [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] [Accepted: 05/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Conduction system pacing (CSP) has emerged as a means to preserve or restore physiological ventricular activation via pacing at the His bundle or at more distal targets in the conduction system, including the left bundle branch area. This review examines strengths, weaknesses, and clinical applications of CSP performed via these approaches. RECENT FINDINGS His bundle pacing (HBP) has been successfully utilized for standard bradyarrhythmia indications and for QRS correction among patients receiving devices for cardiac resynchronization therapy (CRT). Limitations of HBP pacing have included implant complexity and rising pacing thresholds over time. Left bundle branch area pacing (LBBAP) appears to deliver similar physiological benefits with shorter implant times and more stable thresholds. More recently, hybrid systems utilizing HBP or LBBAP in combination with left ventricular leads have been used to treat heart failure (HF) patients, and may be useful in multilevel or mixed conduction blocks. There is growing interest in CSP for bradycardia and HF indications, although high quality data with randomized controlled trials are needed to help guide future treatment paradigms.
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