Left bundle branch area pacing improves right ventricle function and synchrony

Agnieszka Bednarek; Grzegorz Kiełbasa; Paweł Moskal; Aleksandra Ostrowska; Adam Bednarski; Tomasz Sondej; Aleksander Kusiak; Marek Rajzer; Haran Burri; Marek Jastrzębski

doi:10.1016/j.hrthm.2024.05.019

Left bundle branch area pacing improves right ventricle function and synchrony

Heart Rhythm. 2024 May 13:S1547-5271(24)02561-X. doi: 10.1016/j.hrthm.2024.05.019. Online ahead of print.

Authors

Affiliations

¹ First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland; Cardiology, Interventional Cardiac Electrophysiology and Arterial Hypertension Clinical Department, University Hospital, Krakow, Poland. Electronic address: abednarek@su.krakow.pl.
² First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland; Cardiology, Interventional Cardiac Electrophysiology and Arterial Hypertension Clinical Department, University Hospital, Krakow, Poland.
³ Electrophysiology Laboratory, University Hospital in Krakow, Krakow, Poland.
⁴ Cardiology, Interventional Cardiac Electrophysiology and Arterial Hypertension Clinical Department, University Hospital, Krakow, Poland.
⁵ Cardiac Pacing Unit, University Hospital of Geneva, Geneva, Switzerland.
⁶ First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland; Electrophysiology Laboratory, University Hospital in Krakow, Krakow, Poland.

PMID: 38750909
DOI: 10.1016/j.hrthm.2024.05.019

Abstract

Background: The impact of left bundle branch area pacing (LBBAP) on right ventricular (RV) function and tricuspid regurgitation (TR) remains unclear.

Objective: We aimed to assess the long-term effects of LBBAP on RV performance and on TR.

Methods: RV function was evaluated using RV free wall strain (FWS), tricuspid annular plane systolic excursion (TAPSE), fractional area changing (FAC), and systolic (S`) velocity of the lateral tricuspid annulus. The presence of reverse septal flash (RSF) and basal bulge (BB) was used to assess RV motion pattern. The distance between the lead entry site on the interventricular septum and the septal leaflet of the tricuspid annulus was measured (lead-TV distance).

Results: The analysis included 122 subjects (62 males, age 76.5±11.4 years) with a median follow-up of 21 months. During follow-up, RV FWS improved significantly (15.2±5.8 vs 16.4±5.5, p < 0.001), while TAPSE, S`, and FAC remained unchanged. Left ventricular ejection fraction was an independent predictor for improved RV function (B: 3.51, CI 1.39 - 8.9, p = 0.01). With LBBAP, RSF disappeared in 22/23 (96%) patients, and BB in 15/22 (68%) patients in whom RSF and BB were present at baseline, respectively. RV function improvement was significantly higher when RSF was present at baseline (14 vs 11 patients, p = 0.02). At follow-up, no significant deterioration in TR occurred for the overall group. However, a lead-TV distance of < 24.5 mm was associated with TR progression.

Conclusion: LBBAP has a favorable impact on RV function. A basal LBBAP position is associated with worsening TR.

Keywords: dyssynchrony; echocardiogram; left bundle branch area pacing; right ventricle; tricuspid valve regurgitation.