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

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.

scholarly journals Understanding Pacing-Induced Cardiomyopathy: a mini review

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Sidhi Laksono Purwowiyoto ◽  
Reynaldo Halomoan Siregar ◽  
Steven Philip Surya
Keyword(s):  
Cardiac Function ◽  
Right Ventricular ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preventive Strategy ◽  
Ventricular Pacing ◽  
Ventricular Ejection Fraction ◽  
Right Ventricular Pacing

Patients with total atrioventricular block or sinus node dysfunction will need pacemaker implantation to improve the physiologic function of the heart.  It is known that chronic pacing such as right ventricular pacing could deteriorate the cardiac function (decreased left ventricular ejection fraction) due to dyssynchrony. This condition is knows as pacing-induced cardiomyopathy (PICM). The incidence of PICM could reach 19.5% during 3 years follow-up. The right ventricle is one of the locations for implantation. Chronic right ventricular pacing may cause interventricular dyssynchrony and disrupt the contraction mechanism in the heart. These will lead to cardiac remodeling and eventually impair the left ventricular function. Therapy is needed in patients with PICM to improve the symptoms and maintain the cardiac function. This article will further highlight the definition, mechanism, risk factor, treatment and preventive strategy for patients with PICM.

scholarly journals Impact of Physiologic Pacing Versus Right Ventricular Pacing Among Patients With Left Ventricular Ejection Fraction Greater Than 35%: A Systematic Review for the 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

Circulation ◽  
2019 ◽  
Vol 140 (8) ◽  
Author(s):  
David J. Slotwiner ◽  
Merritt H. Raitt ◽  
Freddy Del-Carpio Munoz ◽  
Siva K. Mulpuru ◽  
Naseer Nasser ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Atrioventricular Node ◽  
Chronic Atrial Fibrillation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Pacing ◽  
Ventricular Ejection Fraction ◽  
Right Ventricular Pacing

Background: It is unclear whether physiologic pacing by either cardiac biventricular pacing (BiVP) or His bundle pacing (HisBP) may prevent adverse structural and functional consequences known to occur among some patients who receive right ventricular pacing (RVP). Aim: Our analysis sought to review existing literature to determine if BiVP and/or HisBP might prevent adverse remodeling and be associated with structural, functional, and clinical advantages compared with RVP among patients without severe left ventricular dysfunction (>35%) who required permanent pacing because of heart block. Methods: A literature search was conducted using MEDLINE (through PubMed) and Embase to identify randomized trials and observational studies comparing the effects of BiVP or HisBP versus RVP on measurements of left ventricular dimensions, left ventricular ejection fraction (LVEF), heart failure functional classification, quality of life, 6-minute walk, hospitalizations, and mortality. Data from studies that met the appropriate population, intervention, comparator, and outcomes of interest were abstracted for meta-analysis. Studies that reported pooled outcomes among patients with LVEF both above and below 35% could not be included in the meta-analysis because of strict relationships with industry procedures that preclude retrieval of industry-retained unpublished data on the subset of patients with preserved left ventricular function. Results: Evidence from 8 studies, including a total of 679 patients meeting the prespecified criteria for inclusion, was identified. Results were compared for BiVP versus RVP, HisBP versus RVP, and BiVP+HisBP versus RVP. Among patients who received physiologic pacing with either BiVP or HisBP, the LV end-diastolic and end-systolic volumes were significantly lower (mean duration of follow-up: 1.64 years; –2.77 mL [95% CI –4.37 to –1.1 mL]; P =0.001; and –7.09 mL [95% CI –11.27 to –2.91; P =0.0009) and LVEF remained preserved or increased (mean duration of follow-up: 1.57 years; 5.328% [95% CI: 2.86%–7.8%; P <0.0001). Data on clinical impact such as functional status and quality of life were not definitive. Data on hospitalizations were unavailable. There was no effect on mortality. Several studies stratified results by LVEF and found that patients with LVEF >35% but ≤52% were more likely to receive benefit from physiologic pacing. Patients with chronic atrial fibrillation who underwent atrioventricular node ablation and pacemaker implant demonstrated clear improvement in LVEF with BiVP or HisBP versus RVP. Conclusion: Among patients with LVEF >35%, the LVEF remained preserved or increased with either BiVP or HisBP compared with RVP. However, patient-centered clinical outcome improvement appears to be limited primarily to patients who have chronic atrial fibrillation with rapid ventricular response rates and have undergone atrioventricular node ablation.

scholarly journals Outcomes of conduction system pacing compared to right ventricular pacing as a primary strategy for treating bradyarrhythmia: systematic review and meta-analysis

2021 ◽  
Author(s):  
Amr Abdin ◽  
Suleman Aktaa ◽  
Davor Vukadinović ◽  
Elena Arbelo ◽  
Harran Burri ◽  
...  
Keyword(s):  
Systematic Review ◽  
Right Ventricular ◽  
De Novo ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Pacing ◽  
Ventricular Ejection Fraction ◽  
Right Ventricular Pacing ◽  
Procedure Duration

Abstract Background Right ventricular pacing (RVP) may cause electrical and mechanical desynchrony leading to impaired left ventricular ejection fraction (LVEF). We investigated the outcomes of RVP with His bundle pacing (HBP) and left bundle branch pacing (LBBP) for patients requiring a de novo permanent pacemaker (PPM) for bradyarrhythmia. Methods and results Systematic review of randomized clinical trials and observational studies comparing HBP or LBP with RVP for de novo PPM implantation between 01 January 2013 and 17 November 2020 was performed. Random and fixed effects meta-analyses of the effect of pacing technology on outcomes were performed. Study outcomes included all-cause mortality, heart failure hospitalization (HFH), LVEF, QRS duration, lead revision, atrial fibrillation, procedure parameters, and pacing metrics. Overall, 9 studies were included (6 observational, 3 randomised). HBP compared with RVP was associated with decreased HFH (risk ratio [RR] 0.68, 95% confidence interval [CI] 0.49–0.94), preservation of LVEF (mean difference [MD] 0.81, 95% CI − 1.23 to 2.85 vs. − 5.72, 95% CI − 7.64 to -3.79), increased procedure duration (MD 15.17 min, 95% CI 11.30–19.04), and increased lead revisions (RR 5.83, 95% CI 2.17–15.70, p = 0.0005). LBBP compared with RVP was associated with shorter paced QRS durations (MD 5.6 ms, 95% CI − 6.4 to 17.6) vs. (51.0 ms, 95% CI 39.2–62.9) and increased procedure duration (MD 37.78 min, 95% CI 20.04–55.51). Conclusion Of the limited studies published, this meta-analysis found that HBP and LBBP were superior to RVP in maintaining physiological ventricular activation as an initial pacing strategy.

Predictors of Right ventricular Pacing induced Left Ventricular dysfunction in Pacemaker Recipients with Preserved Ejection Fraction

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Abdelmohsen Sayed ◽  
Emad Effat ◽  
Haitham Badran ◽  
Said Khaled
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Pacing ◽  
Ventricular Ejection Fraction ◽  
Right Ventricular Pacing

Abstract Background Pacemaker (PM) has been an effective treatment in the management of patients with brady-arrhythmias. Chronic RV pacing may cause electrical and mechanical dyssynchrony which lead finally to reduced left ventricular ejection fraction (LVEF). This deterioration of LVEF has been defined as pacemaker induced cardiomyopathy (PICM). The incidence of PICM was described by many studies and ranged between 10% to 26%. The predictors for PICM have not been well studied. These studies were limited by variation in follow-up period and definition of PICM. Objective to study the incidence and predictors of PICM in patients who underwent pacemaker implantation in Ain shams University hospital. Patients and Methods This retrospective study included 160 patients who underwent single or dual chamber pacemaker implantation in Ain shams university hospital between 2010 and 2017 with the mean period 4.7±2.0 years. Implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) patients were excluded. Individuals who had baseline transthoracic echocardiography (TTE) with normal LVEF ≥ 50% before implantation were included. Results This study included 160 patients who had single or dual chamber pacemaker implantation between 2010 and 2017. 45% were males and 55% were females, mean age was 55.5 years. It showed that the incidence of PICM is 7.5%. Wider native QRS durations, particularly &gt;140 ms (p &lt; 0.001), wider pQRS duration &gt;150 ms (p &lt; 0.001), Low normal ejection fraction &lt;56 % preimplantation (p = 0.023) and increased LVEDD&gt;53 mm and LVESD&gt;38 mm (p &lt; 0.001) are predictors for the development of PICM. Female gender was independent predictor for PICM (p = 0.058). There was no association between burden of right ventricular pacing (p = 0.782) or pacing site (p = 0.876) with the risk of development of left ventricular dysfunction. Conclusion The incidence of right ventricular pacing-induced left ventricular dysfunction is not uncommon, with an observed incidence of 7.5% in the current study. Wider native and paced QRS durations, Low normal ejection fraction (&lt; 56 %) pre-implantation and increased LVEDD /LVESD post implantation are the most important predictors for the development of PICM. List of abbreviations PM= pacemaker, RV= Right ventricle, PICM = pacemaker induced cardiomyopathy, TTE= transthoracic echocardiography, DM= Diabetes Mellitus, HTN= Hypertension, BMI= Body Mass index, pQRSd= Paced QRS duration, SWMA= segmental wall motion abnormality, AF= Atrial fibrillation, SSS= Sick sinus syndrome, CHB= Complete heart block, AVB= Atrioventricular block, LVEF = left ventricular ejection fraction, LVEDD= Left ventricular end diastolic diameter, LVESD= Left ventricular end systolic diameter, ms= milli second.

scholarly journals Conduction System Pacing: Basis and Scope

2022 ◽  
Vol 4 (1) ◽  
pp. 01-10
Author(s):  
DR Vivek Kumar ◽  
DR Vanita Arora
Keyword(s):  
Heart Failure ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Heart Failure Hospitalization ◽  
Ventricular Ejection Fraction ◽  
Right Ventricular Pacing ◽  
Increased Risk ◽  
Qrs Duration

Long-term right ventricular pacing (RVP) is associated with more cardiovascular death, atrial fibrillation (AF), thromboembolic complications and heart failure(HF). RVP often results in prolonged QRS duration(QRSd) and ventricular desynchronization. The ventricular desynchronization as a result of RVP leads to an increased risk of heart failure hospitalization (HFH) and AF, and this effect is dependent on cumulative percent ventricular paced ( % VP). In the sub-study from the MOST trial, it was evident that % VP >40% was associated with a 2.6-fold increased risk of HFH compared with pacing < 40% of the time despite preserved atrioventricular synchrony. Moreover this adverse effect of RVP induced ventricular desynchrony was more pronounced in patients with left ventricular ejection fraction( LVEF) of 40% or less resulting in increased death or HFH.

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