Abstract:
Objective: To investigate the clinical safety and electrocardiogram (ECG) characteristics in patients with left bundle branch area pacing (LBBAP). Study Design: Retrospective study. Place and Duration of Study:Department of Cardiology, The First A liated Hospital of Bengbu Medical College, Bengbu, China, from May 2018 to January 2020. Methodology: Patients scheduled for Left Bandle Branch Area Pacing (LBBAP), who were admitted due to bradycardia, had been prospectively recruited. The Medtronic 3830 pacing lead was rst placed at the right ventricular (RV) side of the interventricular septum (IVS) with pacing parameters (pacing threshold, pacing impedance and sensing amplitude) and ECG characteristics [QRS morphology, paced QRS duration and stimulus to peak left ventricular activation time (Sti-LVAT)] measured, which was called the right ventricular septum pacing group (RVSP). Then the pacing lead was screwed towards the left ventricular (LV) side of the IVS; and the corresponding parameters and ECG characteristics were assessed, which was called LBBAP group. Results: RVSP caused left bundle block (LBBB) morphology on ECG, while pacing at left bundle area led to right bundle branch block (RBBB) morphology, without remarkable di erence in pacing threshold and pacing impedance. The sensing amplitude during LBBAP was signi cantly higher compared with RVSP (p <0.05). QRS duration and Sti-LVAT were signi cantly shorter when paced on LBBAP compared with RVSP (p <0.05). Patients with LBBB morphology in intrinsic rhythm showed the greatest reduction in paced QRS duration and Sti-LVAT compared to patients with RBBB morphology or no bundle branch block morphology (p <0.001). There were no complications during pacemaker implantation and no adverse events observed during follow-up. The pacing parameters remained stable during the follow-up (9.2 ± 3.7 months). Conclusion: Compared with pacing on RVSP, patients with LBBAP showed RBBB morphology with signi cantly reduced QRS duration and LV Sti-LVAT under similar pacing parameters. LBBAP is safe and feasible and may be a promising strategy for patients with LBBB morphology who are indicated for ventricular pacing.
Keywords:
Left bundle branch block
,
pacemaker
,
Left bundle branch pacing
,
Right ventricular pacing
,
Physiological pacing