Left bundle branch area pacing results in more physiological ventricular activation than biventricular pacing in patients with left bundle branch block heart failure

0572954 - ÚPT 2024 RIV GB eng J - Journal Article
Süssenbek, O. - Rademakers, L. - Waldauf, P. - Jurák, Pavel - Smíšek, Radovan - Štros, P. - Povišer, L. - Veselá, J. - Plešinger, Filip - Halámek, Josef - Leinveber, P. - Heřman, D. - Osmančík, P. - Čurila, K.
Left bundle branch area pacing results in more physiological ventricular activation than biventricular pacing in patients with left bundle branch block heart failure.
European Heart Journal Supplements. Roč. 25, Supplement E (2023), E17-E24. ISSN 1520-765X. E-ISSN 1554-2815
R&D Projects: GA MZd(CZ) NU21-02-00584
Institutional support: RVO:68081731
Keywords : Heart failure * Biv CRT * LBBAP * Ventricular synchrony * UHF-ECG
OECD category: Cardiac and Cardiovascular systems
Impact factor: 1.6, year: 2022
Method of publishing: Open access
https://academic.oup.com/eurheartjsupp/article/25/Supplement_E/E17/7174252

Biventricular pacing (Biv) and left bundle branch area pacing (LBBAP) are methods of cardiac resynchronization therapy (CRT). Currently, little is known about how they differ in terms of ventricular activation. This study compared ventricular activation patterns in left bundle branch block (LBBB) heart failure patients using an ultra-high-frequency electrocardiography (UHF-ECG). This was a retrospective analysis including 80 CRT patients from two centres. UHF-ECG data were obtained during LBBB, LBBAP, and Biv. Left bundle branch area pacing patients were divided into non-selective left bundle branch pacing (NSLBBP) or left ventricular septal pacing (LVSP) and into groups with V6 R-wave peak times (V6RWPT) < 90 ms and ≥ 90 ms. Calculated parameters were: e-DYS (time difference between the first and last activation in V1-V8 leads) and Vdmean (average of V1-V8 local depolarization durations). In LBBB patients (n = 80) indicated for CRT, spontaneous rhythms were compared with Biv (39) and LBBAP rhythms (64). Although both Biv and LBBAP significantly reduced QRS duration (QRSd) compared with LBBB (from 172 to 148 and 152 ms, respectively, both P < 0.001), the difference between them was not significant (P = 0.2). Left bundle branch area pacing led to shorter e-DYS (24 ms) than Biv (33 ms, P = 0.008) and shorter Vdmean (53 vs. 59 ms, P = 0.003). No differences in QRSd, e-DYS, or Vdmean were found between NSLBBP, LVSP, and LBBAP with paced V6RWPTs < 90 and ≥ 90 ms. Both Biv CRT and LBBAP significantly reduce ventricular dyssynchrony in CRT patients with LBBB. Left bundle branch area pacing is associated with more physiological ventricular activation.
Permanent Link: https://hdl.handle.net/11104/0343477