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

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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Efficiency and safety of his bundle pacing in patients with newly-acquired heart failure after long-term right ventricular pacing, results from China mainland

European Heart Journal ◽

10.1093/ehjci/ehaa946.0718 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y.A.N.G Yiheng ◽

W.A.N.G Kexin ◽

X.I.A Yunlong ◽

D.O.N.G Yingxue

Keyword(s):

Right Ventricular ◽

Clinical Data ◽

Left Ventricular Ejection ◽

Funding Source ◽

Ventricular Pacing ◽

Right Ventricular Pacing ◽

His Bundle ◽

His Bundle Pacing ◽

Nyha Classification

Abstract Background Clinical outcomes of his bundle pacing (HBP) lead implantation in patients with pacing induced cardiomyopathy (PICM) are unknown. We aim to investigate the efficiency and safety of HBP upgrade in a single center. Methods and results Patients with PICM and indication of resynchronization therapy were selected during 2018.1–2019.12. Clinical data including parameters of echocardiographic examination, ECG measurements, New York Heart Association (NYHA) classification were assessed before and after HBP upgrade. HBP upgrade was fulfilled in 38 of 40 (95%) patients. During a mean of 9.36±5.63 months follow-up, 28 patients completed the follow-up of clinical data. The mean age was 67.86±12.85 years and men account for 67.9%. Mean of H-V interval was 56.86±7.11ms. Left ventricular ejection fraction (LVEF) significantly increased from baseline 32.75% to 44.19% (P<0.01). QRS duration decreased from 184.67±27.35 ms at baseline to 123.28±15.82ms with HBP (P<0.01). LVEDD remodeled reversed from 60.85 mm at right ventricular pacing (RVP) implantation to 53.16mm. NYHA functional class improved to 1.96 from 2.64 at baseline during follow-up (P<0.01). Over a median follow-up period of 3.03 (0.9–19.4) months, threshold of his bundle lead decreased from baseline 1.35±0.89mv to 1.2±0.89mv but no significance (P=0.308>0.05). Conclusion HBP significantly improved echocardiographic measurements and NYHA classification for those with PICM. The threshold of his bundle lead is relatively stable in our follow-up period, reminding that the HBP upgrade is safe and effective for PICM patients. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): This study was supported by grants from Liaoning Clinical Capacity Construction Funding (LNCCC-D-20-2015).

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Clinical Outcomes Better with Biventricular versus Right Ventricular Pacing in Patients with Atrioventricular Block

MD Conference Express ◽

10.1177/155989771303005 ◽

2013 ◽

Vol 13 (3) ◽

pp. 12-13

Author(s):

M. Vinall ◽

A. Curtis

Keyword(s):

Right Ventricular ◽

Clinical Outcomes ◽

Atrioventricular Block ◽

Ventricular Pacing ◽

Right Ventricular Pacing

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

European Journal of Echocardiography ◽

10.1093/ejechocard/jer136 ◽

2011 ◽

Vol 12 (10) ◽

pp. 767-772 ◽

Cited By ~ 18

Author(s):

A. E. Albertsen ◽

P. T. Mortensen ◽

H. K. Jensen ◽

S. H. Poulsen ◽

H. Egeblad ◽

...

Keyword(s):

Adverse Effect ◽

Right Ventricular ◽

Biventricular Pacing ◽

Ventricular Pacing ◽

Right Ventricular Pacing ◽

Long Term Follow Up

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Palpography Detects Mechanical Dyssynchrony and Worsens with Right Ventricular Pacing and Reduced Left Ventricular Ejection Fraction

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.2011.03057.x ◽

2011 ◽

Vol 34 (7) ◽

pp. 875-883

Author(s):

DAWOD SHARIF ◽

NAIRA RADZIEVSKY ◽

NEMER SAMNIAH ◽

AMIN HASSAN ◽

ALON KUSHNIR ◽

...

Keyword(s):

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Right Ventricular ◽

Mechanical Dyssynchrony ◽

Left Ventricular ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Ventricular Pacing ◽

Ventricular Ejection Fraction ◽

Right Ventricular Pacing

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Impact of right ventricular dysfunction after MitraClip treatment as a bridge to heart transplantation: insights from the MitraBridge registry

European Heart Journal ◽

10.1093/eurheartj/ehab724.0960 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Munafo ◽

A Scotti ◽

R Estevez-Loureiro ◽

D Arzamendi ◽

N.P Fam ◽

...

Keyword(s):

Heart Transplantation ◽

Right Ventricular ◽

Primary Outcome ◽

Ventricular Dysfunction ◽

Right Ventricular Dysfunction ◽

Left Ventricular ◽

Volume Index ◽

Left Ventricular Ejection ◽

End Point

Abstract Background MitraClip treatment has been recently proposed as a “bridge strategy” solution for advanced heart failure (HF) patients with significant functional mitral regurgitation (MR), who are potential candidates or are waiting for cardiac replacement therapy (LVAD or heart transplantation, HTx). In this clinical scenario, left-ventricular-related right ventricular dysfunction (RVD) represents an important prognostic factor. Purpose Our study aimed to investigate the possible prognostic implication of RVD in advanced HF patients treated with MitraClip as a bridge to HTx strategy. Methods RVD was assessed using the relationship between tricuspid annular peak systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP). All patients from the MitraBridge registry for whom these two echocardiographic parameters were available, were included in the study. A cut-off value of TAPSE/PASP ratio <0.36 was used to defined RVD, as previously reported. The primary outcome was a composite end-point of all-cause death or rehospitalization for HF at 2-year. For patients who underwent LVAD implantation or HTx, follow-up data were censored at the time of those events. Results A total of 80 patients were included in the study. The median TAPSE/PASP ratio was 0.35 (25th-75th: 0.27–0.46), with 43 (54%) patients having a TAPSE/PASP ratio <0.36 (RVD group). The latter had a prevalent MR ischemic etiology (49% vs 38%), with a more frequent history of percutaneous coronary intervention (46.5% vs 22%, p=0.02). Except for TAPSE (15.7±3.6 mm vs 19.2±3.7 mm, p=0.001) and PASP (61±14 mmHg vs 39.5±9.5 mmHg, p<0.001), the other echocardiographic characteristics were similar between the two study groups (overall mean left ventricular ejection fraction 26.9±8%, median left ventricular end-diastolic volume index 120.7, 25th-75th: 102.2–146.5 mL/m2). After a median follow-up time of 508 (25th-75th: 160–899) days, elective HTx occurred in 12 patients (7 from the RVD group), while LVAD implantation was performed in 13 patients (7 from the RVD group). The primary outcome occurred in 30 patients (38%) with a 2-year Kaplan-Meier estimate of freedom from the composite end-point of 41%. At univariate (HR 1.3 95% CI 0.6–2.8, p=0.451) and multivariate (HR 1.6 CI 0.7–3.8, p=0.249) Cox-regression analysis, TAPSE/PASP ratio <0.36 was not identified as an independent predictor of primary outcome. Indeed, at follow-up echocardiographic control (median time 252, 25th-75th: 122–365 days), a significant improvement in TAPSE/PASP ratio was observed in the RVD group (baseline median TAPSE/PASP ratio 0.27, 25th-75th: 0.22–0.32 vs follow-up median TAPSE/PASP ratio 0.37, 25th-75th: 0.28–0.47, p<0.001). Conclusion In advanced HF patients with functional MR, MitraClip treatment could prevent or ameliorate left-ventricular-related RVD, allowing safe access to HTx or LVAD. FUNDunding Acknowledgement Type of funding sources: None.

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