Effects of adaptive left bundle branch–optimized cardiac resynchronization therapy: a single centre experience

BMC Cardiovascular Disorders

Research

Yan Zhao¹  Yi-Chi Yu¹  Xiang-Fei Feng¹  Ling-Chao Yang¹  Bo Liu¹  Yi-Gang Li¹ 

[1] Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, #1665, KongJiang Road, 200092, Shanghai, China;

关键词: Cardiac resynchronization therapy;    Left bundle branch block;    Left bundle branch area pacing;    Heart failure;    Ischaemic cardiomyopathy;   

DOI  :  10.1186/s12872-022-02742-2

 received in 2022-03-26, accepted in 2022-06-30,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundAdaptive cardiac resynchronization therapy (aCRT) is associated with improved clinical outcomes. Left bundle branch area pacing (LBBAP) has shown encouraging results as an alternative option for aCRT. A technique that can be accomplished effectively using LBBAP combined with coronary venous pacing (LOT-aCRT). We aimed to assess the feasibility and outcomes of LOT-aCRT.MethodsLOT-aCRT, capable of providing two pacing modes, LBBAP alone or LBBAP combined with LV pacing, was attempted in patients with CRT indications. Patients were divided into two groups: those with LBBAP and LV pacing (LOT-aCRT) and those with conventional biventricular pacing (BVP-aCRT).ResultsA total of 21 patients were enrolled in the study (10 in the LOT-aCRT group, 11 in the BVP-aCRT group). In the LOT-aCRT group, the QRS duration (QRSd) via BVP was narrowed from 158.0 ± 13.0 ms at baseline to 132.0 ± 4.5 ms (P = 0.019) during the procedure, and further narrowed to 123.0 ± 5.7 ms (P < 0.01) via LBBAP alone. After the procedure, when LOT-aCRT implanted and worked, QRSd was further changed to 121.0 ± 3.8 ms, but the change was not significant (P > 0.05). In the BVP-aCRT group, BVP resulted in a significant reduction in the QRSd from 176.7 ± 19.7 ms at baseline to 133.3 ± 8.2 ms (P = 0.011). However, compared with LOT-aCRT, BVP has no advantage in reducing QRSd and the difference was statistically significant (P < 0.01). During 9 months of follow-up, patients in both groups showed improvements in the LVEF and NT-proBNP levels (all P < 0.01). However, compared with BVP-aCRT, LOT-aCRT showed more significant changes in these parameters (P < 0.01).ConclusionsThe study demonstrates that LOT-aCRT is clinically feasible in patients with systolic heart failure and LBBB. LOT-aCRT was associated with significant narrowing of the QRSd and improvement in LV function.

【 授权许可】

CC BY   
© The Author(s) 2022. corrected publication 2022