Cardiac resynchronization therapy by left bundle branch area pacing in patients with heart failure and left bundle branch block

Weiwei Zhang; Jingjuan Huang; Yiding Qi; Fei Wang; Lina Guo; Xuerui Shi; Weihua Wu; Xiaohong Zhou; Ruogu Li

doi:10.1016/j.hrthm.2019.09.006

Cardiac resynchronization therapy by left bundle branch area pacing in patients with heart failure and left bundle branch block

Heart Rhythm. 2019 Dec;16(12):1783-1790. doi: 10.1016/j.hrthm.2019.09.006. Epub 2019 Sep 9.

Authors

Weiwei Zhang¹, Jingjuan Huang¹, Yiding Qi¹, Fei Wang¹, Lina Guo², Xuerui Shi¹, Weihua Wu², Xiaohong Zhou³, Ruogu Li⁴

Affiliations

¹ Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
² Department of Ultrasound, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
³ CRHF Division, Medtronic plc, Mounds View, Minnesota.
⁴ Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China. Electronic address: 13564565961@163.com.

PMID: 31513945
DOI: 10.1016/j.hrthm.2019.09.006

Abstract

Background: Cardiac resynchronization therapy (CRT) via biventricular pacing has demonstrated clinical benefits in patients with heart failure (HF) and ventricular dyssynchrony. Other approaches of CRT is little known.

Objective: The purpose of this study was to assess the feasibility, safety, and efficacy of left bundle branch area pacing (LBBAP) in patients with HF and left bundle branch block (LBBB).

Methods: Eleven consecutive patients with HF, reduced left ventricular ejection fraction and LBBB and indicated for CRT were recruited. LBBAP was achieved via transventricular septal approach and characterized by narrower QRS duration, shortened peak left ventricular activation time, and right bundle branch conduction delay on the electrocardiogram. Electrocardiogram, echocardiogram, and cardiac function were evaluated at baseline and follow-up. Interventricular mechanical delay and 3-dimensional tissue synchronization imaging during LBBAP and intrinsic LBBB status were measured by echocardiography at follow-up.

Results: LBBAP significantly shortened QRS duration (from baseline 180.00 ± 15.86 ms to 129.09 ± 15.94 ms; P < .01) and left ventricular activation time (from baseline 108.18 ± 15.54 ms to 80.91 ± 9.95 ms; P < .01). Interventricular mechanical delay and the standard deviation of tissue synchronization imaging of 12 left ventricular (LV) segments were significantly shorter during LBBAP than in intrinsic LBBB status (both with P < .01). At a mean follow-up period of 6.7 months, New York Heart Association functional class, plasma level of B-type natriuretic peptide, LV end-systolic diameter, and left ventricular ejection fraction were significantly improved (all with P < .05 vs baseline).

Conclusion: The study demonstrates that LBBAP is clinically feasible in patients with systolic HF and LBBB. LBBAP can be a new CRT technique to correct LBBB, provide ventricular synchrony, and improve clinical symptoms with LV reverse remodeling.

Keywords: Cardiac resynchronization therapy; Heart failure; Left bundle branch area pacing; Left bundle branch block; Ventricular synchrony.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Bundle of His / physiopathology*
Bundle-Branch Block* / diagnosis
Bundle-Branch Block* / physiopathology
Bundle-Branch Block* / surgery
Cardiac Pacing, Artificial* / adverse effects
Cardiac Pacing, Artificial* / methods
Cardiac Resynchronization Therapy / methods*
Electrocardiography / methods
Female
Heart Failure* / diagnosis
Heart Failure* / physiopathology
Heart Failure* / therapy
Heart Ventricles / physiopathology*
Humans
Male
Middle Aged
Pacemaker, Artificial
Treatment Outcome