Comparison of cardiac function between left bundle branch pacing and right ventricular outflow tract septal pacing in the short-term: a registered controlled clinical trial

• Liu Q.
• Yang J.
• Bolun Z.
• Pei M.
• Ma B.
• Tong Q.
• Yin H.
• Zhang Y.
• You L.
• Ruiqin Xiea

Abstract

Background. The novel method of left bundle branch pacing (LBBP) has been reported to produce a narrower QRS duration and lower pacing threshold than right ventricular outflow tract septal pacing (RVOP). However, whether LBBP is superior to traditional RVOP in improving cardiac function still lacks sufficient evidence.

Objective. The purpose of this study was to compare the changes in cardiac function (especially in brain natriuretic peptide (BNP) levels, left atrial function, and left ventricular diastolic function) within 7 days between LBBP and RVOP.

Methods and results. A single-centre prospective controlled registered clinical study was conducted with 84 patients with bradycardia indications. 42 patients underwent RVOP, and 42 patients underwent LBBP. The pacemaker parameters were adjusted so that the ventricular ratio was over 90% and rate was 60-70 bpm. The changes in BNP levels and echocardiogram and speckle-tracking echocardiagraphy findings were compared between the twogroups before andwithin 7 days after implantation.

BNP: there was no significant difference in BNP level between the two groups before and 1 day after implantation, while the LBBP group had significantly lower levels than the RVOP group on day 7 [(65.15±56.96) vs (129.82±101.92) pg/ml, p<0.001].

Cardiac echocardiography: the e' value of the LBBP group was higher than that of the RVOP group 7 days after implantation [(6.39±2.65) vs (5.45±1.35) cm/s, p=0.049]. The E/e' and peak E-wave velocity in the LBBP group decreased significantly after 7 days [16.57±6.55 vs 12.75±5.16, p=0.043; 88.6±24.37 vs 75.68±28.10 cm/s, p=0.030]; in contrast, there were no significant changes in the RVOP group [14.13±3.85 vs14.10±4.85, p=0.50; 77.33±21.14 vs 74.45±23.03 cm/s, p=0.56).

Speckletracking echocardiagraphy: there was no significant difference in left atrial strain or the strain rate between the LBBP and RVOP groups, but the absolute values of left atrial strain and strain rate in the LBBP group increased, while those in the RVOP group decreased.

Conclusion. This study demonstrates that compared to RVOP, LBBP can increase left ventricular early diastolic function, improve BNP levels, and has a tendency to increase left atrialmyocardial elasticity and left atrial strain capacity in the short term in pacemaker-dependent patients.

Keywords:right ventricular outflow tract pacing; left bundle branch pacing; permanent pacemaker; cardiac function; physiological pacing

Литература/References

1. Hussain M.A., Furuya-Kanamori L., Kaye G., Clark J. The effect of right ventricular apical and nonapical pacing on the short- and long-term changes in left ventricular ejection fraction: a systematic review and meta-analysis of randomized-controlled trials. Pacing Clin Electrophysiol. 2015; 38: 1121–36.

2. Karpawich P.P., Rabah R., Haas J.E. Altered cardiac histology following apical right ventricular pacing in patients with congenital atrioventricular block. Pacing Clin Electrophysiol. 1999; 22: 1372–7.

3. Kronborg M.B., Mortensen P.T., Gerdes J.C., Jensen H.K., Nielsen J.C. His and para-His pacing in AV block: feasibility and electrocardiographic findings. J Interv Card Electrophysiol. 2011; 31: 255–62.

4. Francesco Z., Kenneth A.E., Gopi D., et al. Permanent His-bundle pacing: a systematic literature review and meta-analysis. Europace. 2018; 20: 1819–26.

5. Ellenbogen K.A., Padala S.K. His bundle pacing: the holy grail of pacing? J Am Coll Cardiol. 2018; 71 (20): 2331–4.

6. Sharma P.S., Dandamudi G., Herweg B., et al. Permanent his-bundle pacing as an alternative to biventricular pacing for cardiac resynchronization therapy: a multicenter experience. Heart Rhythm. 2018; 15: 413–20.

7. Vijayaraman P., Chung M.K., Dandamudi G., Upadhyay G.A., Krishnan K., Crossley G., et al. His bundle pacing. J Am Coll Cardiol. 2018; 72: 927–47.

8. Shan P., Su L., Zhou X., et al. Beneficial effects of upgrading to His bundle pacing in chronically paced patients with left ventricular ejection fraction <50. Heart Rhythm. 2018; 15 (3): 405–12.

9. Huang W., Su L., Wu S., et al. A novel pacing strategy with low and stable output: pacing the left bundle branch immediately beyond the conduction block. Can J Cardiol. 2017; 33: 1736.e1–3.

10. Chen K., Li Y., Dai Y., et al. Comparison of electrocardiogramcharacteristics and pacing parameters between left bundle branch pacing and right ventricular pacing in patients receiving pacemaker therapy. Europace. 2019; 21 (4): 673–80.

11. Li X., Li H., Ma W., et al. Permanent left bundle branch area pacing for atrioventricular block: feasibility, safety, and acute effect. Heart Rhythm. 2019; 16 (12): 1766–73.

12. Huang W., Chen X., Su L., et al. A beginner’s guide to permanent left bundle branch pacing. Heart Rhythm. 2019; 16: 1791–6.

13. Li Y., Chen K., Dai Y., et al. Left bundle branch pacing for symptomatic bradycardia: implant success rate, safety, and pacing characteristics. Heart Rhythm. 2019; 5: 1547–54.

14. Tasar O., Kocabay G., Karagoz A., et al. Evaluation of left atrial functions by 2- dimensional speckle-tracking echocardiography during healthy pregnancy. J Ultrasound Med. 2019; 38: 2981–8.

15. Copie X. Right ventricular apex pacing: is it obsolete? Dual-chamber pacing is not always the favourite mode in atrioventricular block. Arch Cardiovasc Dis. 2009; 102: 463.

16. Hou X., Qian Z., Wang Y., et al. Feasibility and cardiac synchrony of permanent left bundle branch pacing through the interventricular septum. Europace. 2019; 19: 1–9.

17. Lustgarten D.L., Crespo E.M., Arkhipova-Jenkins I., et al. His-bundle pacing versus biventricular pacing in cardiac resynchronization therapy patients: a crossover design comparison. Heart Rhythm. 2015; 12: 1548–57.

18. Huang W., Su L., Wu S., et al. Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block. Heart. 2019; 2: 137–43.

19. Teng A.E., Lustgarten D.L., Vijayaraman P., et al. Usefulness of his bundle pacing to achieve electrical resynchronization in patients with complete left bundle branch block and the relation between native QRS axis, duration, and normalization. Am J Cardiol. 2016; 118: 527–34.

20. Ferrari A.D., Borges A.P., Albuquerque L.C., Pelzer Sussenbach C., Rosa P.R., Pianta R.M., et al. Cardiomyopathy induced by artificial cardiac pacing: myth or reality sustained by evidence? Rev Bras Cir Cardiovasc. 2014; 29: 402–13.

21. Li Y., Chen K., Dai Y., et al. Left bundle branch pacing for symptomatic bradycardia: implant success rate, safety, and pacing characteristics. Heart Rhythm. 2019; 22: 1547–71.

22. Kim J.H., Kang K.W., Chin J.Y., Kim T.S., Park J.H., Choi Y.J. Major determinant of the occurrence of pacing-induced cardiomyopathy in complete atrioventricular block: a multicentre, retrospective analysis over a 15-year period in South Korea. BMJ Open. 2018; 8: e019048.

23. Khurshid S., Epstein A.E., Verdino R.J., et al. Incidence and predictors of right ventricular pacing-induced cardiomyopathy. Heart Rhythm. 2014; 11: 1619–25.

24. Kanzaki H., Bazaz R., Schwartzman D., Dohi K., Sade L.E., Gorcsan J. A mechanism for immediate reduction in mitral regurgitation after cardiac resynchronization therapy: insights from mechanical activation strain mapping. J Am Coll Cardiol. 2004; 44 (8): 1619–25.

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