Adverse effect of right ventricular pacing prevented by biventricular pacing during long-term follow-up: a randomized comparison

Abstract Aims The aim of this study is to prospectively assess the feasibility and safety of left bundle branch pacing (LBBP) when compared with right ventricular pacing (RVP) during mid-long-term follow-up in a large cohort. Methods and results Patients (n = 554) indicated for pacemaker implantation were prospectively and consecutively enrolled and were non-randomized divided into LBBP group and RVP group. The levels of cTnT and N-terminal pro-B type natriuretic peptide were measured and compared within 2 days post-procedure between two groups. Implant characteristics, procedure-related complications, and clinical outcomes were also compared. Pacing thresholds, sensing, and impedance were assessed during procedure and follow-up. Left bundle branch pacing was feasible with a success rate of 94.8% with high incidence of LBB potential (89.9%), selective LBBP (57.8%), and left deviation of paced QRS axis (79.7%) with mean Sti-LVAT of 65.07 ± 8.58 ms. Paced QRS duration was significantly narrower in LBBP when compared with RVP (132.02 ± 7.93 vs. 177.68 ± 15.58 ms, P < 0.0001) and the pacing parameters remained stable in two groups during 18 months follow-up. cTnT elevation was more significant in LBBP when compared with RVP within 2 days post-procedure (baseline: 0.03 ± 0.03 vs. 0.02 ± 0.03 ng/mL, P = 0.002; 1 day post-procedure: 0.13 ± 0.09 vs. 0.04 ± 0.03 ng/mL, P < 0.001; 2 days post-procedure: 0.10 ± 0.08 vs. 0.03 ± 0.08 ng/mL, P < 0.001). The complications and cardiac outcomes were not significantly different between two groups. Conclusion Left bundle branch pacing was feasible in bradycardia patients associated with stable pacing parameters during 18 months follow-up. Paced QRS duration was significantly narrower than that of RVP. Though cTnT elevation was more significant in LBBP within 2 days post-procedure, the complications, and cardiac outcomes were not significantly different between two groups.

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Right ventricular apical and septal pacing: long term impacts on ventricular function

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.367 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

G Mumin ◽

C Celiker

Keyword(s):

Ejection Fraction ◽

Right Ventricular ◽

Ventricular Pacing ◽

Septal Group ◽

Septal Pacing ◽

Long Term Follow Up ◽

Left And Right ◽

Ventricular Functions

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): The costs of the study were afforded by the researchers. Background In patients requiring permanent pacemaker, in order to protect left and right ventricular functions the optimal pacing site has yet to be determined. Conflicting results exist about septal and apical pacing sites. Aim Our purpose was to evaluate the long term effects of right ventricular apical and septal pacing on left and right ventricular functions. Methods We scanned 378 patients from 2007 to 2012 who received a permanent pacemaker for the treatment of symptomatic bradyarrythmia. As exclusion criteria we identified the patients who did not have an echocardiography before the procedure, those who had co-morbidities which cause reduction in ventricular functions, ejection fraction <%45, patients who died and those who rejected our invitation. 54 women and 66 men were eligible for our study. To determine the patients’ New York Heart Association Class (NYHA) we questioned and did the physical examination. Lead position confirmed by fluoroscopy in two planes, and electrocardiograms were obtained. Finally, we compared the pre-procedural echocardiographic data with our up-to-date findings. Results In sixteen patients the lead placement was inferoseptal and in one hundred and four patients apical site. Median follow up was 9 years. The mean ejection fraction before the implantation was 58,86 ± 4,08 in the apical, and 56,37 ± 8,8 in the septal group (p < 0,05). The long term follow up showed that these values have been reduced, 56,66 ± 8,38 for the apical group and 51,33 ± 13,94 for the septal group, respectively (p < 0,05). Placing the right ventricular lead in both septal and apical site resulted in reduced tricuspid annular plane systolic excursion (from mean 2,25 to 2,18, (p < 0,05)), and in increased systolic pulmonary artery pressure (from 35,46 ± 9,93 to 39,84 ± 11,21 (p < 0,05)). There were no differences regarding the mitral and tricuspid insufficiencies, and diastolic functions before the implantation and long term follow up. These findings were independent of neither the etiology of implanting the pacemaker nor the underlying diseases. Conclusion These two selective ventricular pacing sites caused a reduction in both left and right ventricular functions. Despite the ejection fraction declines, most of these patients have a good quality of life, without symptoms and signs of heart failure. But certainly, there is emerging need for more randomized trials in order to describe the optimal RV pacing site. The main purpose must be preserving better ventricular functions in patients requiring permanent ventricular pacing.

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Long-Term Mortality Outcomes According to the Frequency of Right Ventricular Pacing in Veterans

Cardiology Research and Practice ◽

10.4061/2010/310768 ◽

2010 ◽

Vol 2010 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Brent C. Lampert ◽

Hans J. Moore ◽

Richard L. Amdur ◽

Pamela E. Karasik ◽

Brian M. Lewis ◽

...

Keyword(s):

Right Ventricular ◽

Adverse Outcomes ◽

Equal Proportion ◽

Ventricular Pacing ◽

Right Ventricular Pacing ◽

Time To Death ◽

All Cause Mortality ◽

Long Term Mortality

Background. Right ventricular pacing (RVP) has been associated with adverse outcomes, including heart failure and death. Minimizing RVP has been proposed as a therapeutic goal for a variety of pacing devices and indications.Objective. Quantify survival according to frequency of RVP in veterans with pacemakers.Methods. We analyzed electrograms from transtelephonic monitoring of veterans implanted with pacemakers between 1995 and 2005 followed by the Eastern Pacemaker Surveillance Center. We compared all cause mortality and time to death between patients with less than 20% and more than 80% RVP.Results. Analysis was limited to the 7198 patients with at least six trans-telephonic monitoring records (mean = 21). Average follow-up was 5.3 years. Average age at pacemaker implant was significantly lower among veterans with 20% RVP (67 years versus 72 years; ). An equal proportion of deaths during follow-up were noted for each group: 126/565 patients (22%) with 20% RVP and 1113/4968 patients (22%) with 80% RVP. However, average post-implant survival was 4.3 years with 20% RVP versus 4.7 years with 80% RVP ().Conclusions. Greater frequency (80%) of RVP was not associated with higher mortality in this population of veterans. Those veterans utilizing 20% RVP had a shortened adjusted survival rate ().

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Medium- and Long-Term Lead Stability and Echocardiographic Outcomes of Left Bundle Branch Area Pacing Compared to Right Ventricular Pacing

Journal of Cardiovascular Development and Disease ◽

10.3390/jcdd8120168 ◽

2021 ◽

Vol 8 (12) ◽

pp. 168

Author(s):

Haojie Zhu ◽

Zhao Wang ◽

Xiaofei Li ◽

Yan Yao ◽

Zhimin Liu ◽

...

Keyword(s):

Right Ventricular ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Pacing ◽

Ventricular Ejection Fraction ◽

Right Ventricular Pacing ◽

Procedural Complications ◽

Qrs Duration

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.

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Clinical Outcomes in Patients With Left Bundle Branch Area Pacing vs. Right Ventricular Pacing for Atrioventricular Block

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.685253 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiaofei Li ◽

Junmeng Zhang ◽

Chunguang Qiu ◽

Zhao Wang ◽

Hui Li ◽

...

Keyword(s):

Right Ventricular ◽

Clinical Outcomes ◽

Atrioventricular Block ◽

Primary Outcome ◽

Biventricular Pacing ◽

Left Ventricular Ejection ◽

Ventricular Pacing ◽

Unique Identifier ◽

Right Ventricular Pacing

Background: Left bundle branch area pacing (LBBAP) is a novel pacing modality with stable pacing parameters and a narrow-paced QRS duration. We compared heart failure (HF) hospitalization events and echocardiographic measures between LBBAP and right ventricular pacing (RVP) in patients with atrioventricular block (AVB).Methods and Results: This multicenter observational study prospectively recruited consecutive AVB patients requiring ventricular pacing in five centers if they received LBBAP or RVP and had left ventricular ejection fraction (LVEF) >50%. Data on electrocardiogram, pacing parameters, echocardiographic measurements, device complications, and clinical outcomes were collected at baseline and during follow-up. The primary outcome was first episode hospitalization for HF or upgrade to biventricular pacing. LBBAP was successful in 235 of 246 patients (95.5%), while 120 patients received RVP. During a mean of 11.4 ± 2.7 months of follow-up, the ventricular pacing burden was comparable (83.9 ± 35.1 vs. 85.7 ± 30.0%), while the mean LVEF differed significantly (62.6 ± 4.6 vs. 57.8 ± 11.4%) between the LBBAP and RVP groups. Patients with LBBAP had significantly lower occurrences of HF hospitalization and upgrading to biventricular pacing than patients with RVP (2.6 vs. 10.8%, P <0.001), and differences in primary outcome between LBBAP and RVP were mainly observed in patients with ventricular pacing >40% or with baseline LVEF <60%. The primary outcome was independently associated with LBBAP (adjusted HR 0.14, 95% CI: 0.04–0.55), previous myocardial infarction (adjusted HR 6.82, 95% CI: 1.23–37.5), and baseline LVEF (adjusted HR 0.91, 95% CI: 0.86–0.96).Conclusion: Permanent LBBAP might reduce the risk of HF hospitalization or upgrade to biventricular pacing compared with RVP in AVB patients requiring a high burden of ventricular pacing.Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03851315; URL: http://www.chictr.org.cn; Unique Identifier: ChiCTR2100043296.

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