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Yang Z, Tao J, Fan X, Feng Z, Liu Z. Comparison of clinical outcomes between transthoracic echocardiography- and X-ray-guided left bundle branch pacing for bradycardia: A randomized controlled trial. J Cardiovasc Electrophysiol 2024; 35:875-882. [PMID: 38424662 DOI: 10.1111/jce.16212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/12/2024] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Left bundle branch pacing (LBBP) is a physiological pacing modality. However, the long procedure and fluoroscopy time of LBBP is still a problem. This study aims to compare the clinical outcomes between transthoracic echocardiography (TTE)- and X-ray-guided LBBP. METHODS This is a single-center, prospective, randomized controlled study. Consecutive patients who underwent LBBP in our team from June 2022 to November 2022 were enrolled. Procedure and fluoroscopy time, pacing parameters, electrophysiological and echocardiographic characteristics, as well as complications were recorded at implantation and during follow-up. RESULTS In this study, 60 patients were enrolled and divided into two groups: 30 patients were allocated to the X-ray group and the remaining 30 to the TTE group. There was no significant difference in the success rate between the two groups (86.7% vs. 76.7%, p = .317). The procedure time of TTE group was comparable to that of the X-ray group (9.0 vs. 12.0 min, p = .063). However, the fluoroscopy time in the TTE group was significantly lower than that of the X-ray group (2.5 vs. 5.0 min, p = .002). There were no statistically significant differences in pacing parameters, electrophysiological and echocardiographic characteristics, or complications between the two groups at implantation and during follow-up. CONCLUSION TTE-guided LBBP is a feasible and safe method. Compared with X-ray, TTE showed a comparable success rate and procedure time, but it could significantly reduce the fluoroscopy time of LBBP.
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Affiliation(s)
- Zhihan Yang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Tao
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohan Fan
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhuoxi Feng
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhimin Liu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Verstappen AAA, Hautvast R, Jurak P, Bracke FA, Rademakers LM. Ventricular dyssynchrony imaging, echocardiographic and clinical outcomes of left bundle branch pacing and biventricular pacing. Indian Pacing Electrophysiol J 2024; 24:140-146. [PMID: 38657736 PMCID: PMC11143746 DOI: 10.1016/j.ipej.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Left bundle branch pacing (LBBP) is a novel physiological pacing technique which may serve as an alternative to cardiac resynchronization therapy (CRT) by biventricular pacing (BVP). This study assessed ventricular activation patterns and echocardiographic and clinical outcomes of LBBP and compared this to BVP. METHODS Fifty consecutive patients underwent LBBP or BVP for CRT. Ventricular activation mapping was obtained by ultra-high-frequency ECG (UHF-ECG). Functional and echocardiographic outcomes and hospitalization for heart failure and all-cause mortality after one year from implantation were evaluated. RESULTS LBBP resulted in greater resynchronization vs BVP (QRS width: 170 ± 16 ms to 128 ± 20 ms vs 174 ± 15 to 144 ± 17 ms, p = 0.002 (LBBP vs BVP); e-DYS 81 ± 17 ms to 0 ± 32 ms vs 77 ± 18 to 16 ± 29 ms, p = 0.016 (LBBP vs BVP)). Improvement in LVEF (from 28 ± 8 to 42 ± 10 percent vs 28 ± 9 to 36 ± 12 percent, LBBP vs BVP, p = 0.078) was similar. Improvement in NYHA function class (from 2.4 to 1.5 and from 2.3 to 1.5 (LBBP vs BVP)), hospitalization for heart failure and all-cause mortality were comparable in both groups. CONCLUSIONS Ventricular dyssynchrony imaging is an appropriate way to gain a better insight into activation patterns of LBBP and BVP. LBBP resulted in greater resynchronization (e-DYS and QRS duration) with comparable improvement in LVEF, NYHA functional class, hospitalization for heart failure and all-cause mortality at one year of follow up.
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Affiliation(s)
| | - Rick Hautvast
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Pavel Jurak
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czech Republic
| | - Frank A Bracke
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
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Li M, Li C, Li J, Yu H, Xu G, Gao Y, Xu B, Sun M, Wang Z, Han Y, Liang Y. An individualized criterion for left bundle branch capture in patients with a narrow QRS complex. Heart Rhythm 2024; 21:294-300. [PMID: 37952864 DOI: 10.1016/j.hrthm.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/25/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Left bundle branch (LBB) pacing (LBBP) is a physiological pacing; however, the accuracy of current electrocardiographic criteria for LBBP remains inadequate. OBJECTIVE The purpose of this study was to establish a novel individualized criterion to improve the accuracy of LBBP determination in patients with a narrow QRS complex. METHODS Patients in whom both LBBP and left ventricular septal pacing (LVSP) were acquired during operation were enrolled. LBB conduction time (LBBCT) was measured from LBB potential (LBBpo) to intrinsic QRS onset. LBBpo-V6RWPT, Native-V6RWPT, and Paced-V6RWPT were respectively measured from LBBpo, intrinsic QRS onset, and stimulus to R-wave peak in V6. ΔV6RWPT was the difference value between Paced-V6RWPT and Native-V6RWPT. The accuracy of ΔV6RWPT criterion for determining LBBP was evaluated. RESULTS In all 71 enrolled patients, ΔV6RWPT was <30 ms during LBBP (21.3 ± 4.6 ms; range 9.3-28.3 ms) but was >30 ms during LVSP (38.5 ± 4.6 ms; range 31.1-47.0 ms). The probability distribution of ΔV6RWPT was well separated between LBBP and LVSP. Sensitivity and specificity of the novel criterion of "ΔV6RWPT <30 ms" for determining LBBP both were 100%. However, the optimal cutoff value of Paced-V6RWPT for validation of LBBP was 64.2 ms, and sensitivity and specificity were 84.5% and 97.2%, respectively. Paced-V6RWPT during LBBP was equivalent to LBBpo-V6RWPT in all patients. There was a strong linear correlation between Native-V6RWPT and LBBpo-V6RWPT (r = 0.796; P <.001). CONCLUSION ΔV6RWPT could be an accurate individualized criterion for determining LBB capture with high sensitivity and specificity and was superior over the fixed Paced-V6RWPT criterion.
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Affiliation(s)
- Miaomiao Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Changqing Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Jialin Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Haibo Yu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Guoqing Xu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Yang Gao
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Baige Xu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Mingyu Sun
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Zulu Wang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Yanchun Liang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China.
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Skeete J, Huang HD, Mazur A, Sharma PS, Engelstein E, Trohman RG, Larsen TR. Evolving Concepts in Cardiac Physiologic Pacing in the Era of Conduction System Pacing. Am J Cardiol 2024; 212:51-66. [PMID: 38012990 DOI: 10.1016/j.amjcard.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/22/2023] [Accepted: 11/11/2023] [Indexed: 11/29/2023]
Abstract
Cardiac physiologic pacing (CPP) has become a well-established therapy for patients with cardiomyopathy (left ventricular ejection fraction <35%) in the presence of a left bundle branch block. In addition, CPP can be highly beneficial in patients with pacing-induced cardiomyopathy and patients with existing cardiomyopathy expected to have a right ventricular pacing burden of >40%. The benefits of CPP with traditional biventricular pacing are only realized if adequate resynchronization can be achieved. However, left ventricular lead implantation can be limited by individual anatomic variation within the coronary venous system and can be adversely affected by underlying abnormal myocardial substrate (i.e., scar tissue), especially if located within the basal lateral wall. In the last 7 years the investigation of conduction system pacing (CSP) and its potential salutary benefits are being realized and have led to a rapid evolution in the field of cardiac resynchronization pacing. However, supportive evidence for CSP for patients eligible for cardiac resynchronization remains limited compared with data available for biventricular cardiac resynchronization, mostly derived from leading CSP investigative centers. In this review, we perform an up-to-date comprehensive review of the available literature on CPP.
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Affiliation(s)
- Jamario Skeete
- Division of Cardiac Electrophysiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Henry D Huang
- Division of Cardiac Electrophysiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Alex Mazur
- Division of Cardiac Electrophysiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Parikshit S Sharma
- Division of Cardiac Electrophysiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Erica Engelstein
- Division of Cardiac Electrophysiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Richard G Trohman
- Division of Cardiac Electrophysiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Timothy R Larsen
- Division of Cardiac Electrophysiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.
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Zhang W, He L, Zhang J, Fu G, Sheng X, Pan Y, Zeng G, Li Z, Huang J, Lu H, Shi T, Zhou X, Stadler R, Demmer W, Li R. Electrical Synchrony Optimization for Left Bundle Branch Area Pacing in Patients With Bradycardia and Heart Failure. Am J Cardiol 2023; 203:436-443. [PMID: 37540902 DOI: 10.1016/j.amjcard.2023.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 08/06/2023]
Abstract
Left bundle branch area pacing (LBBAP) has emerged as a promising physiological pacing modality. This study was designed to investigate the acute impact of the atrioventricular delay (AVD) on cardiac electrical characteristics and identify an optimal range of AVDs for LBBAP to achieve electrical atrioventricular and interventricular synchrony. Patients indicated for ventricular or biventricular pacing were studied during routine follow-ups at least 3 months after LBBAP implantation. Patients were excluded if they had a complete AV block or persistent atrial fibrillation. AVD was programed from 40 to 240 ms or until intrinsic conduction occurred. Optimal AVD was determined by the electrocardiography criteria, including QRS duration, reduced R-wave in lead V1, reduced notching or slurring in lateral leads, and more desirable precordial QRS transition. A total of 38 patients (age 68.7 ± 10.3 years; 16 male (42%); 18 dual-chamber pacemakers and 20 cardiac resynchronization therapy devices; average follow-up period 15.1 ± 10.2 months) were included. The fusion of LBBAP and intrinsic right ventricular conduction occurred in 21 patients with corresponding optimal AVD determined. A great proportion (∼85%) of the optimal AVDs ranged from 50% to 80% of the observed atrium-to-left bundle branch-sensing (A-LBBS) intervals. The linear correlation between the optimal AVD and corresponding A-LBBS interval (optimal AVD = 0.84 × [A-LBSs interval] - 36 ms) produced R = 0.86 and p <0.0001. In conclusion, AVD selection during LBBAP greatly impacted the ventricular electrical characteristics and the optimal AVD was linearly correlated with the corresponding A-LBBS interval.
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Affiliation(s)
- Weiwei Zhang
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lang He
- Department of Cardiology, Greentown Hospital, Hangzhou, China
| | - Jiefang Zhang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guosheng Fu
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xia Sheng
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiwen Pan
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guang Zeng
- Department of Cardiology, Greentown Hospital, Hangzhou, China
| | - Zhidi Li
- Department of Cardiology, Greentown Hospital, Hangzhou, China
| | - Jingjuan Huang
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hongyang Lu
- Cardiac Rhythm Management, Medtronic Technology Center, Medtronic (Shanghai) Ltd., Shanghai, China
| | - Tianyi Shi
- Cardiac Rhythm Management, Medtronic Technology Center, Medtronic (Shanghai) Ltd., Shanghai, China
| | - Xiaohong Zhou
- Cardiac Rhythm Management, Medtronic plc., Mounds View, Minnesota
| | - Robert Stadler
- Cardiac Rhythm Management, Medtronic plc., Mounds View, Minnesota
| | - Wade Demmer
- Cardiac Rhythm Management, Medtronic plc., Mounds View, Minnesota
| | - Ruogu Li
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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6
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Pujol-López M, Ferró E, Borràs R, Garre P, Guasch E, Jiménez-Arjona R, Garcia-Ribas C, Doltra A, Niebla M, Carro E, Roca-Luque I, Guichard JB, Puente JL, Uribe L, Vázquez-Calvo S, Castel MÁ, Arbelo E, Porta-Sánchez A, Sitges M, Tolosana JM, Mont L. Stepwise application of ECG and electrogram-based criteria to ensure electrical resynchronization with left bundle branch pacing. Europace 2023; 25:euad128. [PMID: 37294671 PMCID: PMC10254073 DOI: 10.1093/europace/euad128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/13/2023] [Indexed: 06/11/2023] Open
Abstract
AIMS To define a stepwise application of left bundle branch pacing (LBBP) criteria that will simplify implantation and guarantee electrical resynchronization. Left bundle branch pacing has emerged as an alternative to biventricular pacing. However, a systematic stepwise criterion to ensure electrical resynchronization is lacking. METHODS AND RESULTS A cohort of 24 patients from the LEVEL-AT trial (NCT04054895) who received LBBP and had electrocardiographic imaging (ECGI) at 45 days post-implant were included. The usefulness of ECG- and electrogram-based criteria to predict accurate electrical resynchronization with LBBP were analyzed. A two-step approach was developed. The gold standard used to confirm resynchronization was the change in ventricular activation pattern and shortening in left ventricular activation time, assessed by ECGI. Twenty-two (91.6%) patients showed electrical resynchronization on ECGI. All patients fulfilled pre-screwing requisites: lead in septal position in left-oblique projection and W paced morphology in V1. In the first step, presence of either right bundle branch conduction delay pattern (qR or rSR in V1) or left bundle branch capture Plus (QRS ≤120 ms) resulted in 95% sensitivity and 100% specificity to predict LBBP resynchronization, with an accuracy of 95.8%. In the second step, the presence of selective capture (100% specificity, only 41% sensitivity) or a spike-R <80 ms in non-selective capture (100% specificity, sensitivity 46%) ensured 100% accuracy to predict resynchronization with LBBP. CONCLUSION Stepwise application of ECG and electrogram criteria may provide an accurate assessment of electrical resynchronization with LBBP (Graphical abstract).
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Affiliation(s)
- Margarida Pujol-López
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Elisenda Ferró
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Roger Borràs
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Paz Garre
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
| | - Eduard Guasch
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rafael Jiménez-Arjona
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
| | - Cora Garcia-Ribas
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
| | - Adelina Doltra
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Mireia Niebla
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Esther Carro
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
| | - Ivo Roca-Luque
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - J Baptiste Guichard
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - J Luis Puente
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
| | - Laura Uribe
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
| | - Sara Vázquez-Calvo
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - M Ángeles Castel
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Elena Arbelo
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Andreu Porta-Sánchez
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
| | - Marta Sitges
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José M Tolosana
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Lluís Mont
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Lu W, Lin J, Li Y, Hu Q, Cheng C, Chen R, Dai Y, Chen K, Zhang S. Quantitative analysis reveals influencing factors to facilitate successful anodal-ring capture in left bundle branch pacing. Europace 2023; 25:euad172. [PMID: 37337705 PMCID: PMC10292952 DOI: 10.1093/europace/euad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023] Open
Abstract
AIMS Left bundle branch pacing (LBBP) maintains left ventricular synchrony but induces right ventricular conduction delay (RVCD). Although anodal-ring capture (ARC) during bipolar LBBP improves RVCD, it is not achieved in all patients receiving LBBP. This study aimed to analyze the factors influencing ARC implementation. METHODS AND RESULTS Patients receiving LBBP with intraoperative ARC testing were enrolled. Electrocardiographic parameters were measured, including stimulus-to-QRS duration (stim-QRSd), stimulus-to-left/right ventricular activation time (stim-LVAT/RVAT), and V6-V1 interpeak interval. The distribution of lead-tip sites was described as the corrected longitudinal and lateral distance (longit-/lat-dist). Relative angles of the LBBP lead were measured. Echocardiography in short-axis view was used to measure the intraseptal lead length. Intergroup comparisons, correlation analysis, and stepwise logistic regression were performed. In total, 105 patients were included, among which 65 (62%) patients achieved ARC at a pacing output ≤ 5.0 V/0.5 ms (average 3.1 V/0.5 ms). Anodal-ring capture further shortened the stim-QRSd by 13.1 ± 7.5 ms. Better unipolar-ring (cathodal) threshold and R-wave sensing in LBBP-ARC group indicated the critical role of ring-septum contact in ARC. Longer corrected longit-dist and shorter corrected lat-dist of lead-tip sites were positively correlated with higher success likelihood of ARC, likely due to the greater relative angle in which the lead enters the septum and consequently the longer intraseptal lead length and better ring-septum contact. CONCLUSION This study elucidated the factors affecting the success likelihood of LBBP-ARC. These findings improve the understanding of LBBP-ARC, providing references for future research and clinical practice.
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Affiliation(s)
- Wenzhao Lu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Jinxuan Lin
- Department of Cardiovascular Diseases, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Yao Li
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Qingyun Hu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Chendi Cheng
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Ruohan Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Yan Dai
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
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8
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Yu GI, Kim TH, Yu HT, Joung B, Pak HN, Lee MH. Learning Curve Analyses for Left Bundle Branch Area Pacing with Conventional Stylet-Driven Pacing Leads. J Interv Cardiol 2023; 2023:3632257. [PMID: 37251364 PMCID: PMC10212686 DOI: 10.1155/2023/3632257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/31/2023] Open
Abstract
Background Physiological conduction system pacing has attracted attention to overcome the dyssynchrony problems of conventional right ventricular pacing (RVP). Left bundle branch area pacing (LBBAP), which complements short combing of His bundle pacing (HBP), has emerged and has proven its efficiency and safety. In addition, initial experiences of LBBAP were mainly using lumen-less pacing lead, and the feasibility of stylet-driven pacing lead (SDL) was also established. The purpose of this study is to evaluate the learning curve for LBBAP using SDL. Methods The study enrolled 265 patients who underwent LBBAP or RVP performed by operators without previous LBBAP experience at Yonsei University Severance Hospital in Korea between December 2020 and October 2021. LBBAP was performed using SDL with an extendable helix. The learning curve was evaluated by analyzing fluoroscopy and procedure times. And, before and after reaching the learning curve, we evaluated how much the time required for the LBBAP differed from the time required for the RVP. Results LBBAP was successful in 50 of 50 (100.0%) patients left bundle branch pacing was successful in 49 of 50 (98.0%). In 50 patients who underwent LBBAP, mean fluoroscopy and procedural times were 15.1 ± 13.5 minutes and 59.9 ± 24.8 minutes, respectively. The plateau of fluoroscopy time reached in the 25th case and the plateau of procedure time reached in the 24th case. Conclusion During the initial experience with LBBAP, fluoroscopy and procedural times improved with increasing operator experience. For operators who were experienced in cardiac pacemaker implantation, the steepest part of the learning curve was over the first 24-25 cases. It is shorter than the previously reported learning curves of HBP.
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Affiliation(s)
- Ga-In Yu
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, GyeongSang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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9
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Rademakers LM, van den Broek JLPM, Bracke FA. Left bundle branch pacing as an alternative to biventricular pacing for cardiac resynchronisation therapy. Neth Heart J 2023; 31:140-149. [PMID: 35920989 PMCID: PMC10033770 DOI: 10.1007/s12471-022-01712-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Left bundle branch pacing (LBBP) is a novel physiological pacing technique which may serve as an alternative to biventricular pacing (BVP) for the delivery of cardiac resynchronisation therapy (CRT). This study assessed the feasibility and outcomes of LBBP in comparison to BVP. METHODS LBBP was attempted in 40 consecutive patients as the first-line method for delivering CRT. To evaluate LBBP versus BVP, 40 patients with identical inclusion criteria who received BVP were compared with the LBBP group. Acute success rate, complications, functional and echocardiographic outcomes as well as hospitalisation for heart failure and all-cause mortality 6 months after implantation were evaluated. RESULTS LBBP was successfully performed in 31 (78%) patients and resulted in significant QRS narrowing (from 166 ± 16 to 123 ± 18 ms, p < 0.001), improvement in left ventricular ejection fraction (LVEF; from 28 ± 8 to 43 ± 12%, p < 0.001) and New York Heart Association functional class (from 2.8 ± 0.5 to 1.6 ± 0.6, p < 0.001) at 6 months. No LBBP-related complications occurred. Compared to BVP, LBBP resulted in a greater reduction in QRS duration (44 ± 17 vs 15 ± 26 ms, p < 0.001) with comparable absolute improvement in LVEF (15.2 ± 11.7 vs 9.6 ± 12.1%, p = 0.088). Hospitalisation for heart failure and all-cause mortality were similar in the two groups. CONCLUSIONS LBBP is feasible and was safe in 78% of patients with favourable electrical resynchronisation and functional improvement and may serve as an alternative to BVP.
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Affiliation(s)
- L M Rademakers
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
| | | | - F A Bracke
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
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10
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Approach to Left Bundle Branch Pacing. Cardiol Rev 2023:00045415-990000000-00084. [PMID: 36912509 DOI: 10.1097/crd.0000000000000545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Cardiac pacing refers to the implantation tool serving as a treatment modality for various indications, the most common of which is symptomatic bradyarrhythmia. Left bundle branch pacing has been noted in the literature to be safer than biventricular pacing or His-bundle pacing in patients with left bundle branch block (LBBB) and heart failure, thereby becoming the focus of further research on cardiac pacing. A review of the literature was conducted using a combination of keywords, including "Left Bundle Branch Block," "Procedural techniques," "Left Bundle Capture," and "Complications." The following factors have been investigated as key criteria for direct capture: paced QRS morphology, peak left ventricular activation time, left bundle potential, nonselective and selective left bundle capture, and programmed deep septal stimulation protocol. In addition, complications of LBBP, inclusive of septal perforation, thromboembolism, right bundle branch injury, septal artery injury, lead dislodgement, lead fracture, and lead extraction, have also been elaborated on. Despite clinical implications based on clinical research comparing the use of LBBP with other forms such as right ventricular apex pacing, His-bundle pacing, biventricular pacing, and left ventricular septal pacing, a paucity in the literature on long-term effects and efficacy has been noted. LBBP can thus be considered to have a promising future in patients requiring cardiac pacing, assuming that additional research on clinical outcomes and the limitation of significant complications such as thromboembolism can be established.
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11
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Wang M, Sun Y, Shan Y, Zhang J, Sheng X, Ye Y, Yang Y, Fu G. The effectiveness and feasibility of using multi-lead ECG monitoring combined with a programmed intracavitary ECG to complete left bundle branch area pacing. Pacing Clin Electrophysiol 2023; 46:205-216. [PMID: 36788130 DOI: 10.1111/pace.14676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/26/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Left bundle branch area pacing (LBBaP) as an alternative method for delivering physiological pacing, is difficult for many primary hospitals that lack the electrophysiological multichannel recorder to carry out. We hope to find a simple and feasible method that combines the multi-lead surface electrocardiogram (ECG) monitoring and the intracavity ECG of the pacing programmer to achieve LBBaP. METHODS A total of 50 patients with bradycardia indications who attempted permanent pacemaker implantation were included in this study. We referred to multi-lead surface ECG monitoring and pacing system analyzer (PSA), combined with the nine-zone pacing method of the LBBaP, to complete LBBaP. We assessed multiple parameters to verify whether the LBBaP was successfully achieved and used univariable analysis of variance for repeated measures to judge the feasibility and effectiveness of LBBaP without the electrophysiological multichannel recorder. RESULTS LBBaP was successfully archived without the electrophysiological multichannel recorder in 44 of 50 patients (88%). In the study, paced QRS duration and the stimulus to peak left ventricular activation time (Sti-LVAT) were 117.04 ± 10.34 ms and 71.10 ± 7.91 ms and had no significant changes in the 3-month follow-up. The unipolar pacing threshold and R-wave amplitudes were 0.85 ± 0.32 V and 10.36 ± 5.24 mV at baseline respectively, which also showed stability during the 1-month and 3-month follow-up. During the 3-month follow-up, no lead-related complication was recorded. CONCLUSION It is effective and feasible to achieve LBBaP combining the multi-lead ECG monitoring and the intracavitary ECG of PSA without the electrophysiological multichannel recorder, which could be an alternative to perform LBBaP.
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Affiliation(s)
- Min Wang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China.,Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yaxun Sun
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China.,Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yu Shan
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China.,Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Jiefang Zhang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China.,Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Xia Sheng
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China.,Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yang Ye
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China.,Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Ying Yang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China.,Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Guosheng Fu
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China.,Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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12
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Hu Q, You H, Chen K, Dai Y, Lu W, Li Y, Cheng C, Zhou Y, Wang J, Chen R, Zhang S. Distance between the lead-implanted site and tricuspid valve annulus in patients with left bundle branch pacing: Effects on postoperative tricuspid regurgitation deterioration. Heart Rhythm 2023; 20:217-223. [PMID: 36347456 DOI: 10.1016/j.hrthm.2022.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/07/2022] [Accepted: 10/31/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Left bundle branch pacing (LBBP) is an alternative strategy for His-bundle pacing (HBP); however, little is known about tricuspid regurgitation (TR) deterioration after LBBP implantation. OBJECTIVES The purpose of this study was to characterize the incidence of post-LBBP TR deterioration and identify predicting factors, especially lead position parameters. METHODS Patients who received LBBP were continuously enrolled from January 2018 to August 2020. The progression of TR and the anatomic position of LBBP were characterized by echocardiography. RESULTS A total of 89 patients were enrolled and assigned to 2 subgroups based on the degree of TR before LBBP implantation: 58 (65.2%) with relatively normal tricuspid valve (TV) function (grade 0/1 subgroup: with none/trivial or mild TR) and 31 (34.8%) with more severe TR (grade 2/3 subgroup: with moderate or severe TR). At 19.0 ± 6.5 months of follow-up, 29 patients (32.6%) had TR deterioration, and 23 of them were in the grade 0/1 subgroup. In the grade 0/1 subgroup, patients with TR deterioration had a shorter distance between the lead-implanted site and TV (Lead-TA-dist) than those without TR (19.0 ± 7.6 vs 23.9 ± 5.4; P = .006). The receiver operating characteristic (ROC) curve (area under the curve 0.721; 95% confidence interval [CI] 0.575-0.867; P = .005) indicated the favorable efficacy of Lead-TA-dist for predicting TR deterioration after LBBP. Lead-TA-dist ≤16.1 mm was independently associated with TR deterioration after LBBP (hazard ratio 0.20; 95% CI 0.06-0.76; P = .017). CONCLUSION TR was a common complication of LBBP implantation. In patients with none/trivial or mild TR, Lead-TA-dist ≤16.1 mm was an independent predictor of TR deterioration after LBBP implantation.
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Affiliation(s)
- Qingyun Hu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongzhao You
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; State Key Laboratory of Cardiovascular Disease, Endocrine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yan Dai
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Wenzhao Lu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yao Li
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chendi Cheng
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu'an Zhou
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaqi Wang
- Department of Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruohan Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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13
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Zhang J, Zhang Y, Sun Y, Chen M, Wang Z, Ma C. Success rates, challenges and troubleshooting of left bundle branch area pacing as a cardiac resynchronization therapy for treating patients with heart failure. Front Cardiovasc Med 2023; 9:1062372. [PMID: 36704478 PMCID: PMC9872722 DOI: 10.3389/fcvm.2022.1062372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/28/2022] [Indexed: 01/11/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) is an important treatment of heart failure patients with reduced left ventricular ejection fraction (LVEF) and asynchrony of cardiac electromechanical activity. Left bundle branch area pacing (LBBaP) is a novel physiological pacing modality that appears to be an effective method for CRT. LBBaP has several advantages over the traditional biventricular-CRT (BiV-CRT), including a low and stable pacing capture threshold, a high success rate of implantation, a short learning curve, and high economic feasibility. However, LBBaP is not suitable for all heart failure patients needing a CRT and the success rates of LBBaP in heart failure patients is lower because of myocardial fibrosis, non-specific intraventricular conduction disturbance (IVCD), enlargement of the right atrium or right ventricle, etc. In this literature review, we summarize the success rates, challenges, and troubleshooting of LBBaP in heart failure patients needing a CRT.
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Affiliation(s)
- Junmeng Zhang
- Department of Cardiology, Beijing Huaxin Hospital, Tsinghua University, Beijing, China
| | - Yimin Zhang
- Department of Cardiology, Beijing Huaxin Hospital, Tsinghua University, Beijing, China
| | - Yaxun Sun
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengna Chen
- Department of Cardiology, Beijing Huaxin Hospital, Tsinghua University, Beijing, China
| | - Zefeng Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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14
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Li Y, Xing Q, Xiaokereti J, Chen C, Zhang J, Zhou X, Lu Y, Tuerhong Z, Tang B. Right ventriculography improves the accuracy of leadless pacemaker implantation in right ventricular mid-septum. J Interv Card Electrophysiol 2022; 66:941-949. [PMID: 36282369 PMCID: PMC10173092 DOI: 10.1007/s10840-022-01399-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/12/2022] [Indexed: 10/31/2022]
Abstract
Abstract
Background
Implanting leadless pacemakers in the right ventricular (RV) apex is prone to causing pericardial tamponade and myocardial perforation.
Objective
To investigate the feasibility and safety of right ventriculography-guided implantation of Micra™ leadless pacemaker (Micra™, Medtronic, Minneapolis, MN, USA) in the RV mid-septum.
Methods
One hundred eight consecutive patients who underwent Micra™ implantation intended in the mid-septum were enrolled and randomized (3:1) into the radiography group (n = 81) with assistance of right ventriculography to illustrate the RV septum and the non-radiography group (n = 27). All subjects underwent a postoperative computed tomography (CT) scan to determine the Micra™ location. The Micra™ location assessed by CT image was compared between the two groups to confirm the accuracy of the intended pacing site. The duration of the procedure, X-ray radiation dose, and time were also compared between the two groups.
Results
Reconstructed CT 3-D cardiac images found the Micra™ location in the intended mid-septum in 13 patients (48.1%, 13/27) in the non-radiography group and 76 patients (93.8%, 76/81) in the radiography group (P < 0.0001 between two groups). There was no significant difference in procedure interval between the two groups while the X-ray radiation dose (564.86 ± 112.44 vs. 825.85 ± 156.12 mGy, P < 0.0001), X-ray exposure time (7.79 ± 1.43 vs. 12.03 ± 2.86 min, P < 0.0001), and the number of fluoroscopy re-positioning (2.79 ± 1.03 vs. 6.41 ± 1.82, P < 0.0001) were significantly less in the radiography group than in the non-radiography group. No implantation-related complications were observed in both groups.
Conclusion
Right ventriculography increases the accuracy of Micra™ implantation in the mid-septum and reduces X-ray exposure.
Trial registration
The trial registration number (ChiCTR2100051374) and date (09/22/2021).
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15
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Defining the distance between the His bundle and first septal perforator: implications for left bundle branch pacing. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01377-9. [PMID: 36155878 DOI: 10.1007/s10840-022-01377-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/18/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Left bundle branch pacing (LBBP) is a developing method of native conduction pacing, but cases of injury to the septal perforator arteries during implantation have been reported. Knowing the distance between the His bundle and the first septal perforator artery can help operators implant LBBP leads more safely. METHODS Using previously performed coronary CT angiography (CCTA) studies, the distance between the His bundle and the first septal perforator was measured. RESULTS A total of 50 CCTA studies were included. The mean distance from the His bundle to the first septal perforator (His-SP) along the line connecting the His bundle to the RV apex (His-RV apex) was 27.17 ± 7.7 mm with a range of 13.0 to 44.7 mm. The distance was greater than 2.0 cm in 84% of patients. To standardize this distance among patients with varying cardiac structures, the ratio between the His-SP distance and the His-RV Apex distance was also measured. The mean His-SP:His-RV Apex was 0.302 and the median was 0.298. Eighty-six percent of patients had a ratio of greater than 0.20. CONCLUSION Using this information, operators can aim to implant LBBP leads within 2.0 cm of the His bundle or 20% of the distance between the His bundle and the RV apex with minimal risk of causing vascular injury.
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16
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Hu Q, Lu W, Chen K, Dai Y, Lin J, Xu N, Lin J, Chen R, Li Y, Cheng C, Zhou Y, Zhang S. Long-term follow-up results of patients with left bundle branch pacing and exploration for potential factors affecting cardiac function. Front Physiol 2022; 13:996640. [PMID: 36187788 PMCID: PMC9520459 DOI: 10.3389/fphys.2022.996640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Left bundle branch pacing (LBBP) is an alternative strategy for His bundle pacing (HBP). This study aimed to analyze the long-term performance of LBBP and the potential factors affecting long-term cardiac function.Methods: Patients with LBBP were continuously enrolled from January 2018 to August 2020. Pacing parameters, electrocardiogram (ECG), and echocardiography were collected. The anatomic position of LBBP leads was described by echocardiographic and fluoroscopic parameters.Results: A total of 91 patients with a median follow-up of 18 months were enrolled. Most patients maintained stable pacing parameters during follow-up. The intra-septal position of the 3830 lead also remained stable as the distance from the lead tip to the left surface of the ventricular septum was 0.4 (0, 1.4) mm. The overall level of left ventricular ejection fraction (LVEF) slightly increased. 59 patients had improved LVEF (∆LVEF > 0), while 28 patients had unchanged or reduced LVEF (∆LVEF ≤ 0). The declines of baseline LVEF, ∆ Paced QRSd, and corrected longitudinal distance (longit-dist) of lead-implanted site correlated with LVEF improvement, and these three factors had negative linear correlations with ∆LVEF. Patients with tricuspid valve regurgitation (TVR) deterioration had longer follow-up duration (20.5 vs. 15.0 months, p = 0.01) and shorter Lead-TVA-dist (18.6 vs. 21.6 mm, p = 0.04) than those without TVR deterioration.Conclusion: Patients with LBBP generally remained stable in pacing performance, anatomic lead positions, and cardiac function in long-term follow-up. Baseline LVEF, ∆ Paced QRSd, and corrected longit-dist might be associated with potential LVEF decrease, which required further confirmation.
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Affiliation(s)
- Qingyun Hu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenzhao Lu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keping Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Keping Chen,
| | - Yan Dai
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinxuan Lin
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nan Xu
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingru Lin
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruohan Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yao Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chendi Cheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu’an Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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17
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Physiologic Pacing Targeting the His Bundle and Left Bundle Branch: a Review of the Literature. Curr Cardiol Rep 2022; 24:959-978. [PMID: 35678938 DOI: 10.1007/s11886-022-01723-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Conduction system pacing (CSP) has emerged as a means to preserve or restore physiological ventricular activation via pacing at the His bundle or at more distal targets in the conduction system, including the left bundle branch area. This review examines strengths, weaknesses, and clinical applications of CSP performed via these approaches. RECENT FINDINGS His bundle pacing (HBP) has been successfully utilized for standard bradyarrhythmia indications and for QRS correction among patients receiving devices for cardiac resynchronization therapy (CRT). Limitations of HBP pacing have included implant complexity and rising pacing thresholds over time. Left bundle branch area pacing (LBBAP) appears to deliver similar physiological benefits with shorter implant times and more stable thresholds. More recently, hybrid systems utilizing HBP or LBBAP in combination with left ventricular leads have been used to treat heart failure (HF) patients, and may be useful in multilevel or mixed conduction blocks. There is growing interest in CSP for bradycardia and HF indications, although high quality data with randomized controlled trials are needed to help guide future treatment paradigms.
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18
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Rademakers LM, Bouwmeester S, Mast TP, Dekker L, Houthuizen P, Bracke FA. Feasibility, safety and outcomes of upgrading to left bundle branch pacing in patients with right ventricular pacing induced cardiomyopathy. Pacing Clin Electrophysiol 2022; 45:726-732. [PMID: 35510824 DOI: 10.1111/pace.14515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/13/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Right ventricular pacing (RVP) induces abnormal electrical activation and asynchronous ventricular contraction and leads to pacing induced cardiomyopathy (PICM) in 10-20% of patients. Cardiac resynchronization therapy (CRT) utilizing biventricular pacing (BVP) is the recommended treatment. Left bundle branch pacing (LBBP) is a novel physiological pacing technique which may serve as an alternative to CRT. This study assessed feasibility and outcomes of LBBP delivered CRT in patients with PICM. METHODS Twenty consecutive patients with PICM who received an upgrade of their pacemaker to LBBP were prospectively studied. Acute success rate, complications, functional and echocardiographic response and hospitalization for heart failure within six months from implantation were evaluated. RESULTS LBBP was successfully delivered in all patients. Median duration of RVP before upgrade to LBBP was 3.8 years and the RVP percentage was 99. LBBP resulted in significant QRS narrowing (from 193 ± 18 to 130 ± 17 ms (p<0.001)), improvement in LVEF (from 32 ± 6 percent to 47 ± 8 percent (p<0.001)) and NYHA class (from 2.8 ± 0.4 to 1.4 ± 0.5 (p<0.001)) at 6 months. No LBBP-related complications occurred. No patients were hospitalized for heart failure or died. CONCLUSION LBBP is feasible and safe in delivering CRT in PICM. Preliminary analyses demonstrated significant electrical resynchronization and favourable improvement in LV function and NYHA functional class at short term follow-up. Data need to be validated in large randomized controlled trials. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Sjoerd Bouwmeester
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Thomas P Mast
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Lukas Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Frank A Bracke
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
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Zhou Y, Wang J, Wei Y, Zhang W, Yang Y, Rui S, Ju C. Left ventricular septal pacing versus left bundle branch pacing in the treatment of atrioventricular block. Ann Noninvasive Electrocardiol 2022; 27:e12944. [PMID: 35267228 PMCID: PMC9107083 DOI: 10.1111/anec.12944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the feasibility and clinical response of LVSP as an alternative to LBBP. METHODS This was a retrospective study of pacemaker implantation, and 46 consecutive patients with pacemaker implantation were enrolled in the study. The patients were divided into the LBBP and LVSP groups. Electrocardiogram characteristics, pacing parameters, cardiac function, and safety events were assessed during implantation and 12-month follow-up. RESULTS The procedure time was significantly increased in the LBBP group compared with the LVSP group (53.52 ± 14.39 min vs. 38.13 ± 11.52 min, respectively, p = .000). The pacing QRS duration (PQRSD) decreased by 14.09 ± 41.80 ms in the LBBP group and increased by 9.70 ± 29.60 ms in the LVSP group (p = .031). Furthermore, the left ventricle activation time (LVAT) was shorter in the LBBP group than in the LVSP group (48.70 ± 13.67 ms vs. 58.70 ± 13.67 ms, p = .032). During the 12-month follow-up, pacing thresholds remained low and stable, and there was no significant decrease in cardiac function. No adverse event was observed during the follow-up period. CONCLUSIONS Both LBBP and LVSP are safe and feasible methods. LVSP is a good option when multichannel electrophysiological instruments are not available and when the time available for the procedure is limited.
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Affiliation(s)
- Yu Zhou
- Department of EmergencyThe First Affiliated Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Jinfeng Wang
- Department of CardiologyThe First Affiliated Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Youquan Wei
- Department of CardiologyThe First Affiliated Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Wenbo Zhang
- Department of CardiologyThe First Affiliated Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Yuwen Yang
- Department of CardiologyThe First Affiliated Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Shibao Rui
- Department of CardiologyThe First Affiliated Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Changlin Ju
- Department of CardiologyThe First Affiliated Hospital of Wannan Medical CollegeWuhuAnhuiChina
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Chen K, Liu XB, Hou X, Qiu Y, Lin J, Dai Y, Xu YN, Jiang LY, Zhou X, Zhang X, Lu H, Mara N, Demmer W, Cheng A, Zou J. Computed tomography imaging-identified location and electrocardiographic characteristics of left bundle branch area pacing in bradycardia patients. J Cardiovasc Electrophysiol 2022; 33:1244-1254. [PMID: 35419908 DOI: 10.1111/jce.15493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/12/2022] [Accepted: 04/09/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Left bundle branch area pacing (LBBAP) is a novel physiological pacing modality. The relationship between the pacing lead tip location and paced electrocardiographic (ECG) characteristics remains unclear. The objectives are to determine the lead tip location within the interventricular septum (IVS) and assess the location-based ECG QRS duration (QRSd) and left ventricular activation time (LVAT). METHODS This multi-center study enrolled 50 consecutive bradycardia patients who met pacemaker therapy guidelines and received LBBAP implantation via the trans-ventricular septal approach. After at least 3 months post implant, 12-lead ECGs and pacing parameters were obtained. Cardiac computed tomography (CT) imaging was performed to assess the LBBAP lead tip distance from the LV blood pool. RESULTS Among the 50 patients, analyzable CT images were obtained in 42. In 23 of the 42 patients, the lead tips were within 2 mm to the LV blood pool (the LV subendocardial (LVSE) group), 13 between 2 mm and 4 mm (the Near-LVSE group), and the remaining 6 beyond 4 mm (the mid-LV septal (Mid-LVS) group). No significant differences in paced QRSd were found among the 3 groups (LVSE, 107±15 ms; Near-LVSE, 106±13 ms; Mid-LVS, 104±15 ms; P=0.87). LVAT in the LVSE (64±7 ms) was significantly shorter than in the Mid-LVS (72±8 ms; P<0.05), but not significantly different from that in the Near-LVSE (69±8 ms; P>0.05). CONCLUSION In routine LBBAP practice, paced narrow QRSd and fast LVAT, indicative of physiological pacing, was consistently achieved for lead tip location in the LV subendocardial or near LV subendocardial region. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Keping Chen
- Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xing-Bin Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofeng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuanhao Qiu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jinxuan Lin
- Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Dai
- Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan-Ning Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling-Yun Jiang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaohong Zhou
- Cardiac Rhythm Management, Medtronic plc., Mounds View, MN, USA
| | - Xue Zhang
- Cardiac Rhythm Management, Medtronic Technology Center, Medtronic (Shanghai) Ltd., Shanghai, China
| | - Hongyang Lu
- Cardiac Rhythm Management, Medtronic Technology Center, Medtronic (Shanghai) Ltd., Shanghai, China
| | - Nicki Mara
- Cardiac Rhythm Management, Medtronic plc., Mounds View, MN, USA
| | - Wade Demmer
- Cardiac Rhythm Management, Medtronic plc., Mounds View, MN, USA
| | - Alan Cheng
- Cardiac Rhythm Management, Medtronic plc., Mounds View, MN, USA
| | - Jiangang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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21
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Zhang S, Shan Q. Discussion of LBBP synchronization effects in HF patients with LBBB and comparison with BiV-CRT. Heart Fail Rev 2022; 27:2181-2186. [DOI: 10.1007/s10741-021-10213-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 11/24/2022]
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22
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Zhang J, Pan Y, Sun Y, Fu G. Anatomical and histological assessment of left bundle branch area pacing in human heart with refractory heart failure. ESC Heart Fail 2022; 9:1478-1482. [PMID: 35038791 PMCID: PMC8934916 DOI: 10.1002/ehf2.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/18/2021] [Accepted: 01/04/2022] [Indexed: 11/09/2022] Open
Abstract
As an emerging pacing technique, left bundle branch area pacing (LBBAP) has served as a physiological pacing modality that overcomes the limitations of His bundle pacing (HBP) or right ventricular pacing. Three patients with terminal heart failure who were waiting for heart transplantation and met the indications of pacemaker implantations received LBBAP. Symptoms were relieved and stabilized and eventually received heart transplantation. Diseased hearts from the recipients were dissected post‐transplantation, and the direct visual of pacing lead locations in the interventricular septum were evaluated, and the histopathological examination around the lead was conducted for the first time in human. As a result, we found that the locations of LBBAP leads were matched with fluoroscopic views during the procedure and Masson's staining showed extensive fibrosis occur around the lead but did not result in high thresholds.
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Affiliation(s)
- Jiefang Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University of Medicine, Hangzhou, Zhejiang, 310016, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310016, China
| | - Yiwen Pan
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University of Medicine, Hangzhou, Zhejiang, 310016, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310016, China
| | - Yaxun Sun
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University of Medicine, Hangzhou, Zhejiang, 310016, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310016, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University of Medicine, Hangzhou, Zhejiang, 310016, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310016, China
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Nogami A, Kurita T, Kusano K, Goya M, Shoda M, Tada H, Naito S, Yamane T, Kimura M, Shiga T, Soejima K, Noda T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Kohsaka S, Mitamura H. JCS/JHRS 2021 guideline focused update on non‐pharmacotherapy of cardiac arrhythmias. J Arrhythm 2022; 38:1-30. [PMID: 35222748 PMCID: PMC8851582 DOI: 10.1002/joa3.12649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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24
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Nogami A, Kurita T, Kusano K, Goya M, Shoda M, Tada H, Naito S, Yamane T, Kimura M, Shiga T, Soejima K, Noda T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Kohsaka S, Mitamura H. JCS/JHRS 2021 Guideline Focused Update on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2022; 86:337-363. [PMID: 34987141 DOI: 10.1253/circj.cj-21-0162] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
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25
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Initial experience, feasibility and safety of permanent left bundle branch pacing: results from a prospective single-centre study. Neth Heart J 2021; 30:258-266. [PMID: 34837151 PMCID: PMC9043049 DOI: 10.1007/s12471-021-01648-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Left bundle branch (LBB) pacing is a novel pacing technique which may serve as an alternative to both right ventricular pacing for symptomatic bradycardia and cardiac resynchronisation therapy (CRT). A substantial amount of data is reported by relatively few, highly experienced centres. This study describes the first experience of LBB pacing in a high-volume device centre. Methods Success rates (i.e. the ability to achieve LBB pacing), electrophysiological parameters and complications at implant and up to 6 months of follow-up were prospectively assessed in 100 consecutive patients referred for various pacing indications. Results The mean age was 71 ± 11 years and 65% were male. Primary pacing indication was atrioventricular (AV) block in 40%, CRT in 42%, and sinus node dysfunction or refractory atrial fibrillation prior to AV node ablation in 9% each. Baseline left ventricular ejection fraction was < 50% in 57% of patients, mean baseline QRS duration 145 ± 34 ms. Overall LBB pacing was successful in 83 of 100 (83%) patients but tended to be lower in patients with CRT pacing indication (69%, p = ns). Mean left ventricular activation time (LVAT) during LBB pacing was 81 ms and paced QRS duration was 120 ± 19 ms. LBB capture threshold and R‑wave sense at implant was 0.74 ± 0.4 mV at 0.4 ms and 11.9 ± 5.9 V and remained stable at 6‑month follow-up. No complications occurred during implant or follow-up. Conclusion LBB pacing for bradycardia pacing and resynchronisation therapy can be easily adopted by experienced implanters, with favourable success rates and safety profile.
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26
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Lu W, Lin J, Chen K, Dai Y, Chen R, Hu Q, Li Y, Cheng C, Zhou Y, Zhang S. Quantitative distance and electrocardiographic parameters for lead-implanted site selection to enhance the success likelihood of left bundle branch pacing. Clin Res Cardiol 2021; 111:1219-1230. [PMID: 34761309 DOI: 10.1007/s00392-021-01965-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Left bundle branch pacing (LBBP) is a novel near-physiological pacing method that still lacks quantitative criteria to guide the selection of lead-implanted sites to enhance the success likelihood of lead deployments. This study aimed to quantitatively analyze the relationships of LBBP success likelihood to the distribution of lead-implanted sites and the lead-localization-pacing electrocardiographic (ECG) features. METHODS All the lead-implanted sites in patients with finally successful LBBP were enrolled for analysis, including successful and failed sites. A novel coordinate system was invented to describe the sites' distribution as longitudinal distance (longit-dist) and lateral distance (lat-dist). Corrected distance parameters were generated to eliminate the cardiac dimension variations. The lead-localization-pacing ECG parameters were also collected, such as paced QRS duration (locat-QRSd), left ventricular activation time (locat-LVAT), LVAT/QRSd ratio (locat-LVAT/QRSd), and QRS directions. RESULTS A total of 94 patients with 105 successful sites and 93 failed sites were enrolled. Longit-dist and corrected longit-dist of successful sites were significantly longer, while locat-QRSd and locat-LVAT were shorter and locat-LVAT/QRSd was lower than failed sites. There was a positive dose-response relationship between LBBP success likelihood and corrected longit-dist with a cut-off of 26.95 mm, whereas there were negative dose-response relationships of LBBP success likelihood to locat-QRSd, locat-LVAT, and locat-LVAT/QRSd with the cut-offs of 142 ms, 92 ms, and 64.7%, respectively. Downward QRS direction in II/III ECG leads was also associated with successful LBBP. CONCLUSION Longit-dist, locat-QRSd, locat-LVAT, and locat-LVAT/QRSd were quantitative parameters to guide the selection of lead-implanted sites during LBBP implantation. Quantitative distance and electrocardiographic parameters for lead-implanted site selection to enhance the success likelihood of left bundle branch pacing. LBBP, left bundle branch pacing; Longit-dist, longitudinal distance; CL-apex-dist, distance from contraction line to apex; LBBB, left bundle branch block; IVCD, intraventricular conduction delay; Locat-QRSd, lead-localization-pacing QRS duration; Locat-LVAT, lead-localization-pacing left ventricular activation time; Locat-LVAT/QRSd, lead-localization-pacing LVAT/QRSd ratio.
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Affiliation(s)
- Wenzhao Lu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jinxuan Lin
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Yan Dai
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Ruohan Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Qingyun Hu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Yao Li
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Chendi Cheng
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Yu'an Zhou
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
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27
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Lin J, Hu Q, Chen K, Dai Y, Chen R, Sun Q, Zhou Y, Yan L, Lu W, Li Y, Jin Y, Chen F, Gold MR, Zhang S. Relationship of paced left bundle branch pacing morphology with anatomic location and physiological outcomes. Heart Rhythm 2021; 18:946-953. [PMID: 33781981 DOI: 10.1016/j.hrthm.2021.03.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/09/2021] [Accepted: 03/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Left bundle branch pacing (LBBP) is an emerging physiological pacing modality. However, little is known about pacing at different locations on the left bundle branch (LBB). OBJECTIVE The purpose of this study was to explore pacing and physiological characteristics associated with different LBBP locations. METHODS The study included 68 consecutive patients with normal unpaced QRS duration and successful LBBP implantation. Patients were divided into 3 groups according to the paced QRS complex as left bundle branch trunk pacing (LBTP), left posterior fascicular pacing (LPFP), or left anterior fascicular pacing (LAFP). Electrocardiographic (ECG) characteristics, pacing parameters, and fluoroscopic localization were collected and analyzed. RESULTS There were 17 (25.0%), 35 (51.5%), and 16 (23.5%) patients in the LBTP, LPFP, and LAFP groups, respectively. All subgroups had relatively narrow paced QRS complex (128.6 ± 9.1 ms vs 133.7 ± 11.2 ms vs 134.8 ± 9.6 ms; P = .170), fast left ventricular activation (70.4 ± 9.0 ms vs 70.6 ± 10.2 ms vs 71.0 ± 9.0 ms; P = .986), as well as low and stable pacing thresholds. Delayed right ventricular activation and interventricular dyssynchrony were similar between groups. Fluoroscopic imaging indicated that the lead tip was located most commonly in the basal-middle region of the septum (67.7%), and this was independent of paced QRS morphology group (88.2% vs 57.1% vs 68.8%; P = .106). CONCLUSION Pacing at different sites of the LBB resulted in similar intraventricular and interventricular electrical synchrony in patients with an intact conduction system. Fluoroscopic imaging alone could not predict specific LBBP paced ECG morphology.
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Affiliation(s)
- Jinxuan Lin
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qingyun Hu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yan Dai
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Ruohan Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu'an Zhou
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lirong Yan
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenzhao Lu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yao Li
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuanhao Jin
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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28
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Liu P, Wang Q, Sun H, Qin X, Zheng Q. Left Bundle Branch Pacing: Current Knowledge and Future Prospects. Front Cardiovasc Med 2021; 8:630399. [PMID: 33834042 PMCID: PMC8021709 DOI: 10.3389/fcvm.2021.630399] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/05/2021] [Indexed: 12/16/2022] Open
Abstract
Cardiac pacing is an effective therapy for treating patients with bradycardia due to sinus node dysfunction or atrioventricular block. However, traditional right ventricular apical pacing (RVAP) causes electric and mechanical dyssynchrony, which is associated with increased risk for atrial arrhythmias and heart failure. Therefore, there is a need to develop a physiological pacing approach that activates the normal cardiac conduction and provides synchronized contraction of ventricles. Although His bundle pacing (HBP) has been widely used as a physiological pacing modality, it is limited by challenging implantation technique, unsatisfactory success rate in patients with wide QRS wave, high pacing capture threshold, and early battery depletion. Recently, the left bundle branch pacing (LBBP), defined as the capture of left bundle branch (LBB) via transventricular septal approach, has emerged as a newly physiological pacing modality. Results from early clinical studies have demonstrated LBBP's feasibility and safety, with rare complications and high success rate. Overall, this approach has been found to provide physiological pacing that guarantees electrical synchrony of the left ventricle with low pacing threshold. This was previously specifically characterized by narrow paced QRS duration, large R waves, fast synchronized left ventricular activation, and correction of left bundle branch block. Therefore, LBBP may be a potential alternative pacing modality for both RVAP and cardiac resynchronization therapy with HBP or biventricular pacing (BVP). However, the technique's widespread adaptation needs further validation to ascertain its safety and efficacy in randomized clinical trials. In this review, we discuss the current knowledge of LBBP.
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Affiliation(s)
- Peng Liu
- Department of Cardiology, The Second Affiliate Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiaozhu Wang
- Department of Cardiology, The Second Affiliate Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hongke Sun
- Department of Cardiology, The Second Affiliate Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinghua Qin
- School of Life Sciences, Northwestern Polytechnical University, Xi'an, China
| | - Qiangsun Zheng
- Department of Cardiology, The Second Affiliate Hospital of Xi'an Jiaotong University, Xi'an, China
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Zhong C, Xu W, Shi S, Zhou X, Zhu Z. Left bundle branch pacing for cardiac resynchronization therapy: A systematic literature review and meta-analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:497-505. [PMID: 33491220 DOI: 10.1111/pace.14174] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/05/2021] [Accepted: 01/18/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Left bundle branch pacing (LBBP) recently has been suggested as an alternative modality to deliver cardiac resynchronization therapy (CRT). Data on LBBP for CRT are limited to small sample reports, and clinical benefits and risks have not been systematically assessed. We sought to systematically examine published studies of LBBP for CRT and quantify the feasibility and efficacy of the therapy. METHODS Cochrane Library, PubMed, Web of Science, and Embase databases were searched from inception to September 30, 2020 to identify relevant studies evaluating LBBP in patients for CRT. Clinical outcomes of interest included implant success rate, QRS duration (QRSd), pacing threshold, left ventricular (LV) function at baseline and follow-up, heart failure-related hospitalization, and mortality. Data were extracted and summarized. RESULTS A total of six studies (two single-arm studies and four comparative studies) involving 174 patients were included. The results showed that the average age of patients was 64.9 years and all were implanted for CRT. The procedural success rate was only reported in two studies (97% and 81.1%, respectively). LBBP resulted in a narrow of mean QRSd from 172.7 ± 4.8 to 115.1 ± 7.6 ms. LV function, including LV ejection fraction and LV end-diastolic dimension improved at follow-up. During a mean follow-up of 8.1 months, 1.3% of patients experienced heart failure-related hospitalization and no patients died. CONCLUSION LBBP is a feasible strategy with significant efficacy and safety for CRT candidates.
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Affiliation(s)
- Chenghao Zhong
- Department of Cardiology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Wei Xu
- Department of Cardiology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Shunyi Shi
- Department of Cardiology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xiujuan Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhenyan Zhu
- Department of Cardiology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China
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Co ML, Khouzam JP, Pour-Ghaz I, Minhas S, Basu-Ray I. Emerging Technologies in Cardiac Pacing From Leadless Pacers to Stem Cells. Curr Probl Cardiol 2021; 46:100797. [PMID: 33561694 DOI: 10.1016/j.cpcardiol.2021.100797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 01/28/2023]
Abstract
Modern pacemakers can sense and pace multiple chambers of the heart. These pacemakers have different modes and features to optimize atrioventricular synchrony and promote intrinsic conduction. Despite recent advancements, current pacemakers have several drawbacks that limit their feasibility. In this review article, we discuss several of these limitations and detail several emerging technologies in cardiac pacing aimed to solve some of these limitations. We present several technological advancements in cardiac pacing, including the use of leadless pacemakers, physiologic pacing, battery improvements, and bioartificial pacemakers. More research still needs to be done in testing the safety and efficacy of these new developments.
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Affiliation(s)
- Michael Lawren Co
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA
| | | | - Issa Pour-Ghaz
- Department of Cardiology, University of Tennessee Health Science Center, Memphis, TN
| | - Sheharyar Minhas
- Department of Internal Medicine, Baptist Memorial Hospital, Memphis, TN
| | - Indranill Basu-Ray
- Arrythmia Service, Department of Cardiology, Memphis VA Medical Center, The University of Memphis, Memphis, TN.
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31
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Li Y, Yan L, Dai Y, Zhou Y, Sun Q, Chen R, Lin J, Jin Y, Chen F, Guo X, Chen K, Zhang S. Feasibility and efficacy of left bundle branch area pacing in patients indicated for cardiac resynchronization therapy. Europace 2020; 22:ii54-ii60. [PMID: 33370801 DOI: 10.1093/europace/euaa271] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/11/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS The present study was to evaluate the feasibility and clinical outcomes of left bundle branch area pacing (LBBAP) in cardiac resynchronization therapy (CRT)-indicated patients. METHODS AND RESULTS LBBAP was performed via transventricular septal approach in 25 patients as a rescue strategy in 5 patients with failed left ventricular (LV) lead placement and as a primary strategy in the remaining 20 patients. Pacing parameters, procedural characteristics, electrocardiographic, and echocardiographic data were assessed at implantation and follow-up. Of 25 enrolled CRT-indicated patients, 14 had left bundle branch block (LBBB, 56.0%), 3 right bundle branch block (RBBB, 12.0%), 4 intraventricular conduction delay (IVCD, 16.0%), and 4 ventricular pacing dependence (16.0%). The QRS duration (QRSd) was significantly shortened by LBBAP (intrinsic 163.6 ± 29.4 ms vs. LBBAP 123.0 ± 10.8 ms, P < 0.001). During the mean follow-up of 9.1 months, New York Heart Association functional class was improved to 1.4 ± 0.6 from baseline 2.6 ± 0.6 (P < 0.001), left ventricular ejection fraction (LVEF) increased to 46.9 ± 10.2% from baseline 35.2 ± 7.0% (P < 0.001), and LV end-diastolic dimensions (LVEDD) decreased to 56.8 ± 9.7 mm from baseline 64.1 ± 9.9 mm (P < 0.001). There was a significant improvement (34.1 ± 7.4% vs. 50.0 ± 12.2%, P < 0.001) in LVEF in patients with LBBB. CONCLUSION The present study demonstrates the clinical feasibility of LBBAP in CRT-indicated patients. Left bundle branch area pacing generated narrow QRSd and led to reversal remodelling of LV with improvement in cardiac function. LBBAP may be an alternative to CRT in patients with failure of LV lead placement and a first-line option in selected patients such as those with LBBB and heart failure.
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Affiliation(s)
- Yuqiu Li
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing 100037, China
| | - Lirong Yan
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing 100037, China
| | - Yan Dai
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing 100037, China
| | - Yu'an Zhou
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing 100037, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing 100037, China
| | - Ruohan Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing 100037, China
| | - Jinxuan Lin
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing 100037, China
| | - Yuanhao Jin
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing 100037, China
| | - Feng Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing 100037, China
| | - Xiaogang Guo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing 100037, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing 100037, China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing 100037, China
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Zhang J, Sheng X, Pan Y, Wang M, Fu G. Electrophysiological Insights into Three Modalities of Left Bundle Branch Area Pacing in Patients Indicated for Pacing Therapy. Int Heart J 2020; 62:78-86. [PMID: 33390564 DOI: 10.1536/ihj.20-490] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Left bundle branch pacing (LBBP) has been adopted as a new pacing therapy whether in routine pacing or patients with heart failure, but the criteria for a completely captured LBBP are too complicated and have a low success rate in routine clinical practice.Consecutive patients with pacing therapy indications were enrolled. Left bundle branch area pacing (LBBAP) was conducted, and the presence of LBB potential, paced QRS duration, stimulus to left ventricular activation time (Stim-LVAT), and LBB potential to left ventricular activation time (LBB po-LVAT) were determined and utilized to characterize LBBAP modalities. Pacing parameters and safety were assessed at 6-month follow-up. LBBAP succeeded in 95.6% of patients (103/106) who completed the 6-month follow-up. Complete LBBP was achieved in 21 (20%) patients, characterized with a short Stim-LVAT equal to LBB po-LVAT. Incomplete LBBP was achieved in 58 (56%) patients with a short Stim-LVAT equal to LBB po-LVAT at a high pacing output and a relatively longer Stim-LVAT at a low pacing output. Deep septal pacing (DSP) characterized with no LBB potential and a longer Stim-LVAT (83.3 ± 7.7 ms) than that in LBBP (71.37 ± 7.1 ms, P < 0.01 versus DSP) was observed in 24 (23%) patients. Complete LBBP had a longer total procedure time and longer fluoroscopic time than the other two groups.This study describes the similarities and differences in electrophysiological characteristics and the possible mechanisms of the different types of LBBAP, classified into 3 modalities in routine clinical practice, each with narrow paced QRS duration and stable parameters, indicating LBBAP can be a near-physiological pacing modality.
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Affiliation(s)
- Jiefang Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University of Medicine
| | - Xia Sheng
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University of Medicine
| | - Yiwen Pan
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University of Medicine
| | - Min Wang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University of Medicine
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University of Medicine
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Guo J, Li L, Xiao G, Ye T, Huang X, Meng F, Li Q, Chen S, Cai B. Remarkable response to cardiac resynchronization therapy via left bundle branch pacing in patients with true left bundle branch block. Clin Cardiol 2020; 43:1460-1468. [PMID: 32960993 PMCID: PMC7724211 DOI: 10.1002/clc.23462] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Left bundle branch pacing (LBBP) has been suggested as an alternative means to deliver cardiac resynchronization therapy (CRT). HYPOTHESIS LBBP may deliver resynchronization therapy along with an advantage over traditional biventricular (BiV) pacing in clinical outcomes. METHODS Heart failure patients who presented LBBB morphology according to Strauss's criteria and received successful CRT procedure were enrolled in the present study. Propensity score matching was applied to match patients into LBBP-CRT group and BiV-CRT group. Then, the electrographic data, the echocardiographic data and New York heart association (NYHA) class were compared between the groups. RESULTS Twenty-one patients with successful LBBP procedure and another 21 matched patients with successful BiV-CRT procedure were finally enrolled in the study. The QRS duration (QRSd) was narrowed from 167.7 ± 14.9 ms to 111.7 ± 12.3 ms (P < .0001) in the LBBP-CRT group and from 163.6 ± 13.8 ms to 130.1 ± 14.0 ms (P < .0001) in the BiV-CRT group. A trend toward better left ventricular ejection fraction (LVEF) was recorded in the LBBP-CRT group (50.9 ± 10.7% vs 44.4 ± 13.3%, P = .12) compared to that in the BiV-CRT group at the 6-month follow-up. A trend toward better echocardiographic response was documented in patients receiving LBBP-CRT procedure (90.5% vs 80.9%, P = .43) and more super CRT response was documented in the LBBP-CRT group (80.9% vs 57.1%, P = .09) compared to that in the BiV-CRT group. CONCLUSIONS LBBP-CRT can dramatically improve the electrical synchrony in heart failure patients with LBBB. Meanwhile, compared with the traditional BiV-CRT, it has a tendency to significantly improve LVEF and enhance the NYHA cardiac function scores.
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Affiliation(s)
- Jincun Guo
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Linlin Li
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Guosheng Xiao
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Tao Ye
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Xinyi Huang
- Division of Echocardiography, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Fanqi Meng
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Qiang Li
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Simei Chen
- Division of Cardiac Function, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Binni Cai
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
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Hu Y, Li H, Gu M, Hua W, Niu H, Zhang N, Liu X, Chen X, Hou C, Zhou X, Zhang S. Comparison between his-bundle pacing and left bundle branch pacing in patients with atrioventricular block. J Interv Card Electrophysiol 2020; 62:63-73. [PMID: 32954478 DOI: 10.1007/s10840-020-00869-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pacing the cardiac conduction system has been explored in patients with conduction system disease, but comprehensive comparisons between different pacing modalities are not well investigated. OBJECTIVE To compare pacing characteristics and ventricular synchrony between His-bundle pacing (HBP) and left bundle branch pacing (LBBP) in patients with atrioventricular block (AVB). METHODS Fifty pacemaker-indicated patients with AVB were enrolled. Twenty-five patients underwent HBP, and another 25 patients underwent LBBP. Success rate, procedural and fluoroscopy duration, pacing parameters, and echocardiographic data were perioperatively assessed and at 3-month follow-up. RESULTS HBP was successful in 19 of 25 (76.0%) patients, whereas LBBP was successful in 22 of 25 (88.0%) patients. Compared with HBP, LBBP capture threshold was significantly lower (0.76 ± 0.25 V/0.4 ms vs. 1.27 ± 0.61 V/1.0 ms, P = 0.003) and R-wave amplitude was significantly higher with LBBP (11.7 ± 6.6 vs. 4.9 ± 2.4 mV, P < 0.001) at implant. The mean procedural time (74.3 ± 17.8 vs. 63.2 ± 12.3 min, P = 0.029) and fluoroscopy duration (10.3 ± 4.5 vs. 6.8 ± 2.2 min, P = 0.005) were significantly longer in the HBP group compared to LBBP. At 3-month follow-up, pacing capture threshold remained more stable in LBBP than in HBP group while left ventricular synchrony was similar between both groups. CONCLUSION Despite similar impact on ventricular synchrony compared with HBP, LBBP featured a significantly lower pacing capture threshold, higher R-wave amplitude, and less time to achieve similar success rate in patients with AVB. These findings indicate LBBP as a physiological pacing strategy for AVB patients.
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Affiliation(s)
- Yiran Hu
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Beijing, 100070, China.,The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Hui Li
- Department of Ultrasound, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China
| | - Min Gu
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Wei Hua
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.167, Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Hongxia Niu
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Nixiao Zhang
- Department of Ultrasound, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China
| | - Xi Liu
- Department of Ultrasound, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China
| | - Xuhua Chen
- Department of Ultrasound, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China
| | - Cuihong Hou
- Department of Ultrasound, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China
| | - Xiaohong Zhou
- Cardiac Rhythm and Heart Failure, Medtronic plc, Mounds View, MN, 55112, USA
| | - Shu Zhang
- Department of Ultrasound, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China
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Ponnusamy SS, Bopanna D, Kumar S. Electroanatomical Mapping-Guided Low Fluoroscopy Left Bundle Branch Pacing. JACC Clin Electrophysiol 2020; 6:1045-1047. [DOI: 10.1016/j.jacep.2020.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 11/25/2022]
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Lin J, Chen K, Dai Y, Sun Q, Li Y, Jiang Y, Zhou Y, Chen R, Jin Y, Yan L, Zhou X, Cheng A, Zhang X, Gold MR, Zhang S. Bilateral Bundle Branch Area Pacing to Achieve Physiological Conduction System Activation. Circ Arrhythm Electrophysiol 2020; 13:e008267. [DOI: 10.1161/circep.119.008267] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Left bundle branch pacing (LBBP) is a technique for conduction system pacing, but it often results in right bundle branch block morphology on the ECG. This study was designed to assess simultaneous pacing of the left and right bundle branch areas to achieve more synchronous ventricular activation.
Methods:
In symptomatic bradycardia patients, the distal electrode of a bipolar pacing lead was placed at the left bundle branch area via a transventricular-septal approach. This was used to pace the left bundle branch area, while the ring electrode was used to pace the right bundle branch area. Bilateral bundle branch area pacing (BBBP) was achieved by stimulating the cathode and anode in various pacing configurations. QRS duration, delayed right ventricular activation time, left ventricular activation time, and interventricular conduction delay were measured. Pacing stability and short-term safety were assessed at 3-month follow-up.
Results:
BBBP was successfully performed in 22 of 36 patients. Compared with LBBP, BBBP resulted in greater shortening of QRS duration (109.3±7.1 versus 118.4±5.7 ms,
P
<0.001). LBBP resulted in a paced right bundle branch block configuration, with a delayed right ventricular activation time of 115.0±7.5 ms and interventricular conduction delay of 34.0±8.8 ms. BBBP fully resolved the right bundle branch block morphology in 18 patients. In the remaining 4 patients, BBBP partially corrected the right bundle branch block with delayed right ventricular activation time decreasing from 120.5±4.7 ms during LBBP to 106.1±4.2 ms during BBBP (
P
=0.005).
Conclusions:
LBBP results in a relatively narrow QRS complex but with an interventricular activation delay. BBBP can diminish the delayed right ventricular activation, producing more physiological ventricular activation.
Graphic Abstract:
A
graphic abstract
is available for this article.
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Affiliation(s)
- Jinxuan Lin
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yan Dai
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yuqiu Li
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yong Jiang
- State Key Laboratory of Cardiovascular Disease, Department of Echocardiography (Y. Jiang), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yu’an Zhou
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ruohan Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yuanhao Jin
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Lirong Yan
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaohong Zhou
- Medtronic Inc, Cardiac Rhythm Heart Failure Division, Minneapolis, MN (X. Zhou, A.C.)
| | - Alan Cheng
- Medtronic Inc, Cardiac Rhythm Heart Failure Division, Minneapolis, MN (X. Zhou, A.C.)
| | - Xue Zhang
- Medtronic (Shanghai) Ltd, Shanghai, China (X. Zhang)
| | - Michael R. Gold
- Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.)
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center (J.L., K.C., Y.D., Q.S., Y.L., Y.Z., R.C., Y. Jin, L.Y., S.Z.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Ponnusamy SS, Muthu G, Kumar M, Bopanna D, Anand V, Kumar S. Mid-term feasibility, safety and outcomes of left bundle branch pacing-single center experience. J Interv Card Electrophysiol 2020; 60:337-346. [PMID: 32623624 DOI: 10.1007/s10840-020-00807-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND His bundle pacing (HBP) has evolved as the most physiological form of pacing but associated with limitations. Recently, left bundle branch pacing (LBBP) is emerging as an effective alternative strategy for HBP. OBJECTIVES Our study was designed to assess the feasibility, efficacy, electrophysiological parameters, and mid-term outcomes of LBBP in Indian population. METHODS All patients requiring permanent pacemaker implantation for symptomatic bradycardia and heart failure were prospectively enrolled. Echocardiography, QRS duration, pacing parameters, left bundle (LB) potentials, paced QRS duration, and peak left ventricular activation time (pLVAT) were recorded. RESULTS LBBP was successful in 93 out of 99 patients (94% acute success). Mean age was 62.6 ± 13 years, male 59%, diabetes 69%, and coronary artery disease 65%. Follow-up duration was 4.8 months (range1-12 months). Indication for pacing included atrioventricular (AV) block 43%, cardiac resynchronization therapy 44%, and AV node ablation 4%. LB potential was noted in 37 patients (40%). QRS duration reduced from 144.38 ± 34.6 at baseline to 110.8 ± 12.4 ms after LBBP (p < 0.0001). Pacing threshold was 0.59 ± 0.22 V and sensed R wave 14.14 ± 7.19 mV, and it remained stable during follow-up. Lead depth in the septum was 9.62 mm. LV ejection fraction increased from 44.96 to 53.3% after LBBP (p < 0.0001). One died due to respiratory tract infection on follow up. CONCLUSION LBBP is a safe and effective strategy (94% acute success) of physiological pacing. The pacing parameters remained stable over a period of 12 months follow-up. LBBP can effectively overcome the limitations of HBP.
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Affiliation(s)
- Shunmuga Sundaram Ponnusamy
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Velammal Village, Airport ring road, Madurai, Tamilnadu, 625009, India.
| | - Giridhar Muthu
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Velammal Village, Airport ring road, Madurai, Tamilnadu, 625009, India
| | - Mahesh Kumar
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Velammal Village, Airport ring road, Madurai, Tamilnadu, 625009, India
| | - Dasarath Bopanna
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Velammal Village, Airport ring road, Madurai, Tamilnadu, 625009, India
| | - Vijesh Anand
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Velammal Village, Airport ring road, Madurai, Tamilnadu, 625009, India
| | - Surya Kumar
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Velammal Village, Airport ring road, Madurai, Tamilnadu, 625009, India
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38
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Guo J, Li L, Xiao G, Huang X, Li Q, Wang Y, Cai B. Feasibility and stability of left bundle branch pacing in patients after prosthetic valve implantation. Clin Cardiol 2020; 43:1110-1118. [PMID: 32609400 PMCID: PMC7533988 DOI: 10.1002/clc.23413] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Left bundle branch pacing (LBBP) has emerged as a promising pacing modality for preventing pacing induced cardiomyopathy in patients complicated with conduction abnormalities (CAs) after prosthetic valve (PV) implantation. OBJECTIVE The present study aimed to evaluate the safety and feasibility of LBBP in this patient population. METHODS LBBP was attempted in 20 patients complicated with atrioventricular block after PV implantation. Surface, intracardiac electrical measurements, and echocardiographic data were documented. Lead parameters and complications were routinely tracked at implantation and each follow-up visit. RESULTS LBBP was successful in 90% (18/20) participants. The paced QRS duration and the stimulus to left ventricular activation time were 106.8 ± 6.8 ms and 65.5 ± 5.4 ms, respectively. Left bundle branch (LBB) potential was recorded in 61.1% (11/18) patients who succeeded in LBBP. During the procedure, the mean unipolar myocardium capture threshold was 0.51 ± 0.15 V@0.4 ms while the unipolar bundle capture threshold was 0.84 ± 0.51 V@0.4 ms. The mean fluoroscopic exposure time and the radiation dose were 13.0 ± 9.2 min and 81.7 ± 8.3 mGy, respectively. The average follow-up period was 10.4 ± 5.9 months (range 3-23 months). Pacing parameters remained stable and no significant lead-related complications occurred during the whole observation period. CONCLUSIONS LBBP was safe and feasible in patients with PVs. Acceptable and stable pacing parameters could be expected during the procedure and the follow-ups.
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Affiliation(s)
- Jincun Guo
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Linlin Li
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Guosheng Xiao
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Xinyi Huang
- Division of Echocardiography, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Qiang Li
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Yan Wang
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Binni Cai
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
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Sundaram S, Vijayaraman P. Left bundle branch pacing. Herzschrittmacherther Elektrophysiol 2020; 31:124-134. [PMID: 32458056 DOI: 10.1007/s00399-020-00694-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
Chronic right ventricular (RV) pacing has been associated with significant electrical and mechanical dyssynchrony leading to increased risk for recurrent heart failure hospitalizations and atrial arrhythmias. His bundle pacing (HBP) is an effective alternative to RV pacing as it is physiological and provides synchronized contraction of both ventricles. But there are limitations to HBP, which include lead stability, rise in threshold, early battery depletion and longer learning curve. Huang et al. recently reported a novel technique to directly capture the left bundle branch (LBB) by deep septal pacing. Subsequently, many studies have demonstrated the feasibility, safety and efficacy of left bundle branch pacing (LBBP). This has the potential to overcome the limitations of HBP and provide a safe technique to capture the conduction system in patients with distal His bundle and proximal bundle branch disease. The criteria for LBB capture and the methodology to perform LBBP are discussed in detail in this review. The Medtronic SelectSecure®3830 pacing lead is used along with a fixed-curve C315His® or a deflectable C304His® sheath. LBBP provides safe and low threshold compared to HBP. Left bundle potential should be demonstrable in all patients except in those with infrahisian complete heart block (CHB) and complete left bundle branch block (LBBB), wherein antegrade activation of the left bundle will not occur. LBBP has the potential to be an effective alternative to biventricular pacing or HBP in patients with left ventricular dysfunction, LBBB and recurrent heart failure. Long-term safety and clinical outcomes compared to traditional pacing need to be carefully studied in randomized clinical trials.
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Affiliation(s)
| | - Pugazhendhi Vijayaraman
- Cardiac Electrophysiology, Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, MC 36-10, 1000 E Mountain Blvd, 18711, Wilkes-Barre, PA, USA.
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Zhang J, Wang Z, Zu L, Cheng L, Su R, Wang X, Liang Z, Chen J, Hang F, Du J, Huang W, Wu Y. Simplifying Physiological Left Bundle Branch Area Pacing Using a New Nine-Partition Method. Can J Cardiol 2020; 37:329-338. [PMID: 32428620 DOI: 10.1016/j.cjca.2020.05.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/26/2020] [Accepted: 05/08/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Left bundle branch area pacing (LBBaP) is accepted as a physiological form of pacing; however, it is complex and usually requires an expensive electrophysiological recording system. METHODS A simplified approach ("9-partition method") was explored to perform LBBaP. In this method, a right anterior oblique 30° fluoroscopic image of the ventricle was divided into 9 sections ("3 × 3" partitions). From May 2018 to February 2019, we enrolled 51 consecutive patients who underwent pacemaker implantation. The patients were nonrandomly allocated to either the conventional LBBaP (c-LBBaP) group or simplified LBBaP (s-LBBaP) group. RESULTS The mean age was 68.53 ± 11.90 years, and 32 (62.7%) patients were male. The overall success rate was 90.2% (46/51). Compared with the c-LBBaP group, the s-LBBaP group had a significantly lower total procedure duration (91.57 ± 19.51 minutes vs 70.68 ± 13.26 minutes; P < 0.001) and fluoroscopy duration (16.52 ± 5.34 minutes vs 10.54 ± 3.13 minutes; P < 0.001). The time from the 3830 lead and sheath passage through the tricuspid valve to an acceptable initial fixation site (4.69 ± 1.61 minutes vs 2.75 ± 1.04 minutes; P < 0.001) and the time to the left bundle branch lead being implanted successfully (11.78 ± 3.00 minutes vs 7.67 ± 2.45 minutes; P < 0.001) for the c-LBBaP vs s-LBBaP groups, respectively, were significantly different. After 3 months, there were no significant differences in the capture threshold, R wave amplitude, impedance, or QRS duration between the groups. CONCLUSIONS Compared with the c-LBBaP approach, our simplified 9-partition method was faster and did not require an expensive electrophysiological recording system.
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Affiliation(s)
- Junmeng Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zefeng Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Linna Zu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Liting Cheng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ruijuan Su
- Department of Ultrasound, Beijing Jishuitan Hospital, Beijing, China
| | - Xinlu Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhuo Liang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jieruo Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fei Hang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Du
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China; The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Capital Medical University, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Weijian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Yongquan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Cai B, Huang X, Li L, Guo J, Chen S, Meng F, Wang H, Lin B, Su M. Evaluation of cardiac synchrony in left bundle branch pacing: Insights from echocardiographic research. J Cardiovasc Electrophysiol 2020; 31:560-569. [PMID: 31919928 PMCID: PMC7027438 DOI: 10.1111/jce.14342] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/30/2019] [Accepted: 01/06/2020] [Indexed: 12/22/2022]
Abstract
AIM The aim of this study is to assess if left bundle branch pacing (LBBP) can preserve physiological cardiac synchrony and deliver favorable hemodynamic effects. METHODS Consecutive patients undergoing dual chamber pacemaker implantation for sick sinus syndrome (SSS) and a normal cardiac function with a narrow QRS complex were recruited for the study. Electrocardiogram and echocardiographic examinations were performed during ventricular pacing-on and native-conduction modes. The QRS duration (QRSd), systolic dyssynchrony index (SDI), and the standard deviation of time-to-peak contraction velocity in left ventricular (LV) 12 segments (Tsd-12-LV) were measured to evaluate LV synchrony. The stroke volume (SV) and the degree of atrioventricular valvular regurgitation were also assessed. RESULTS A total of 40 patients underwent LBBP, while another 38 patients underwent right ventricular septum pacing (RVSP) as control group. Baseline characteristics were similar between the two groups. With LBBP, the paced QRSd was slightly wider than the intrinsic QRSd (101.03 ± 8.79 ms vs 91.06 ± 14.17 ms, P < .0001) while the LV mechanical synchrony during LBBP pacing mode was similar to that of native-conduction mode (SDI, 3.14 ± 2.49 vs 2.70 ± 1.68, P = 0.129; Tsd-12-LV, 26.43 ± 15.55 vs 25.61 ± 16.07, P = .671) in the LBBP group. The LV synchrony in the LBBP group was superior to the RVSP group significantly. No significant differences in SV (64.08 ± 16.97 mL vs 65.45 ± 18.68 mL, P = .241) or the degree of atrioventricular valvular regurgitation were noted between LBBP capture and native-conduction modes. CONCLUSION LBBP could preserve satisfactory LV synchrony and result in favorable hemodynamic effects.
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Affiliation(s)
- Binni Cai
- Department of Cardiology, Xiamen Cardiovascular HospitalXiamen UniversityXiamenFujianChina
| | - Xinyi Huang
- Department of Echocardiography, Xiamen Cardiovascular HospitalXiamen UniversityXiamenFujianChina
| | - Linlin Li
- Department of Cardiology, Xiamen Cardiovascular HospitalXiamen UniversityXiamenFujianChina
| | - Jincun Guo
- Department of Cardiology, Xiamen Cardiovascular HospitalXiamen UniversityXiamenFujianChina
| | - Simei Chen
- Department of Cardiac Function, Xiamen Cardiovascular HospitalXiamen UniversityXiamenFujianChina
| | - Fanqi Meng
- Department of Cardiology, Xiamen Cardiovascular HospitalXiamen UniversityXiamenFujianChina
| | - Huimin Wang
- Department of Echocardiography, Xiamen Cardiovascular HospitalXiamen UniversityXiamenFujianChina
| | - Biqin Lin
- Department of Echocardiography, Xiamen Cardiovascular HospitalXiamen UniversityXiamenFujianChina
| | - Maolong Su
- Department of Echocardiography, Xiamen Cardiovascular HospitalXiamen UniversityXiamenFujianChina
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42
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Zhang S, Zhou X, Gold MR. Left Bundle Branch Pacing. J Am Coll Cardiol 2019; 74:3039-3049. [DOI: 10.1016/j.jacc.2019.10.039] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/15/2019] [Accepted: 10/28/2019] [Indexed: 11/24/2022]
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