Abstract
The long-term lead stability and echocardiographic outcomes of left bundle branch area pacing (LBBAP) are not fully understood. This study aimed to observe the mid-long-term clinical impact of LBBAP compared to right ventricular pacing (RVP). Consecutive bradycardia patients undergoing LBBAP or RVP were enrolled. Pacing and electrophysiological characteristics, echocardiographic measurements, and procedural complications were prospectively recorded at baseline and follow-up. LBBAP was successful in 376 of 406 patients (92.6%), while 313 patients received RVP. During a mean follow-up of 13.6 ± 7.8 months, LBBAP presented with similar pacing parameters and complications to RVP, except a significantly narrower paced QRS duration (115.7 ± 12.3 ms vs. 148.0 ± 18.0 ms, p < 0.001). In 228 patients with ventricular pacing burden >40%, LBBAP at last follow-up resulted in decreased left atrial diameter (LAD) (40.1 ± 8.5 mm vs. 38.5 ± 8.0 mm, p < 0.001) while RVP produced decreased left ventricular ejection fraction (62.7 ± 4.8% vs. 60.5 ± 6.9%, p < 0.001) when compared to baseline. After adjusting for age, the presence of atrial fibrillation, and other clinical factors, LBBAP was still associated with a decrease in LAD (−1.601, 95% CI −3.094–−0.109, p = 0.036). We conclude that LBBAP might result in more preserved echocardiographic outcomes than RVP.
Highlights
Left bundle branch area pacing (LBBAP), first reported by Huang et al [1], has emerged as a physiological pacing technique alternative to His bundle pacing (HBP) with stable and low capture threshold and high R wave amplitude [2]
The main findings are as follows: (1) LBBAP demonstrated favorable lead performance and pacing parameters similar to right ventricular pacing (RVP) during mid-long-term follow-up; (2) LBBAP resulted in significantly narrower QRSd, reduced left atrial diameter (LAD), and preserved Left ventricular ejection fraction (LVEF) in patients with VP ≥ 40% compared with RVP; (3) lead-related complications of LBBAP were low and similar to that of RVP
Our results provide evidence for mid-long-term lead stability and safety of LBBAP, and the potential effect of LBBAP on cardiac reverse remodeling compared with RVP
Summary
Left bundle branch area pacing (LBBAP), first reported by Huang et al [1], has emerged as a physiological pacing technique alternative to His bundle pacing (HBP) with stable and low capture threshold and high R wave amplitude [2]. A large single-center cohort study demonstrated the long-term safety and feasibility of LBBAP in patients with symptomatic bradycardia or advanced heart failure [6]. Few data are available regarding comparisons of lead stability and clinical outcomes between LBBAP and RVP. Chen et al reported comparisons of the mid-long-term feasibility and safety between LBBAP and RVP, but echocardiographic outcomes were not analyzed during follow-up [7]. The present study aimed to compare the lead stability and echocardiographic outcomes between LBBAP and RVP during midlong-term follow-up
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