Effect of left bundle branch pacing on right ventricular function: A 3-dimensional echocardiography study

Fangyan Tian; Haobo Weng; Ao Liu; Wen Liu; Bei Zhang; Yanan Wang; Yufei Cheng; Shan Cheng; Zibire Fulati; Nianwei Zhou; Dehong Kong; Cuizhen Pan; Yangang Su; Nuo Xu; Haiyan Chen; Xianhong Shu

doi:10.1016/j.hrthm.2023.12.012

Effect of left bundle branch pacing on right ventricular function: A 3-dimensional echocardiography study

Heart Rhythm. 2024 Apr;21(4):445-453. doi: 10.1016/j.hrthm.2023.12.012. Epub 2023 Dec 24.

Authors

Fangyan Tian¹, Haobo Weng², Ao Liu², Wen Liu³, Bei Zhang⁴, Yanan Wang³, Yufei Cheng³, Shan Cheng⁴, Zibire Fulati³, Nianwei Zhou³, Dehong Kong³, Cuizhen Pan³, Yangang Su⁵, Nuo Xu⁶, Haiyan Chen⁷, Xianhong Shu⁸

Affiliations

¹ Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai Institute of Medical Imaging, Shanghai, China; Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China; Department of Ultrasound Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
² Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai Institute of Medical Imaging, Shanghai, China; Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China.
³ Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai Institute of Medical Imaging, Shanghai, China.
⁴ Department of Ultrasound Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
⁵ Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China.
⁶ Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai Institute of Medical Imaging, Shanghai, China; Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China. Electronic address: nuonuo0819@126.com.
⁷ Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai Institute of Medical Imaging, Shanghai, China; Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China. Electronic address: chen.haiyan@zs-hospital.sh.cn.
⁸ Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai Institute of Medical Imaging, Shanghai, China; Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China. Electronic address: shu.xianhong@zs-hospital.sh.cn.

PMID: 38147906
DOI: 10.1016/j.hrthm.2023.12.012

Abstract

Background: The effect of left bundle branch pacing (LBBP) on right ventricular (RV) function is not well known, and there is conflicting evidence regarding whether cardiac resynchronization therapy improves RV function.

Objectives: The study aimed to investigate the effect of LBBP on RV function and to evaluate the response of RV dysfunction (RVD) to LBBP.

Methods: Sixty-five LBBP candidates were prospectively included in the study and underwent echocardiography at baseline and 6-month follow-up. LBBP response was left ventricular (LV) reverse remodeling, defined as a reduction in LV end-systolic volume of ≥15% at follow-up.

Results: Patients were assigned to 2 subgroups on the basis of 3-dimensional echocardiography-derived RV ejection fraction (EF) before LBBP implantation: 30 patients (46%) in the no RVD group and 35 patients (54%) in the RVD group. The RVD group was characterized by higher N-terminal pro-brain natriuretic peptide levels, New York Heart Association functional class, and larger LV/RV size. LBBP induced a significant reduction in QRS duration, LV size, and improvement in LVEF and mechanical dyssynchrony in both the no RVD and RVD groups, and a significant improvement in RV volumes and RVEF in the RVD group (all P<.01). LBBP resulted in a similar percentage reduction in QRS duration, LV dimensions, LV volumes, and percentage improvement in LVEF in RVD and no RVD groups (all P＞.05). LV reverse remodeling (29 of 35 patients vs 27 of 30 patients; P = .323) in the RVD group was similar to that in the no RVD group after LBBP.

Conclusion: LBBP induces excellent electrical and mechanical resynchronization, with a significant improvement in RV volumes and function. RVD did not diminish the beneficial effects on LV reverse remodeling after LBBP.

Keywords: Cardiac resynchronization therapy; Heart failure; Left bundle branch pacing; Right ventricular function; Three-dimensional echocardiography.

MeSH terms

Bundle of His
Cardiac Pacing, Artificial / methods
Cardiac Resynchronization Therapy* / methods
Echocardiography
Electrocardiography
Heart Conduction System
Heart Ventricles / diagnostic imaging
Humans
Stroke Volume / physiology
Treatment Outcome
Ventricular Function, Left / physiology
Ventricular Function, Right*