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Cardiac resynchronization therapy in heart failure patients by using left bundle branch pacing
BACKGROUND: Left bundle branch pacing (LBBP) is emerging as an effective alternative to achieve cardiac resynchronization therapy (CRT) and improve heart function. The purpose of our study was to investigate the feasibility and efficacy of LBBP in heart failure patients with left ventricular ejectio...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9445246/ https://www.ncbi.nlm.nih.gov/pubmed/36082131 http://dx.doi.org/10.3389/fcvm.2022.990016 |
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author | Gu, Ying Li, Yanming Zhu, Ying Lin, Xiuyu Tian, Tian Zhang, Qigao Gong, Jianbin Wang, Lei Li, Jianhua |
author_facet | Gu, Ying Li, Yanming Zhu, Ying Lin, Xiuyu Tian, Tian Zhang, Qigao Gong, Jianbin Wang, Lei Li, Jianhua |
author_sort | Gu, Ying |
collection | PubMed |
description | BACKGROUND: Left bundle branch pacing (LBBP) is emerging as an effective alternative to achieve cardiac resynchronization therapy (CRT) and improve heart function. The purpose of our study was to investigate the feasibility and efficacy of LBBP in heart failure patients with left ventricular ejection fraction (LVEF) <50% and left bundle branch block (LBBB). METHODS: All patients with complete LBBB and LVEF <50% were retrospectively included in the study from April 2018 to April 2021 and underwent CRT via LBBP implantation. ECG, pacing parameters, the New York Heart Association (NYHA) functional class, echocardiographic measurements, and complications were recorded and analyzed at implant and during follow-up of 1, 6, and 12 months. RESULTS: Left bundle branch pacing was successful in all 34 patients (mean age 65.6 ± 11.2 years, 67.6% men). A significant decrease in QRS duration (QRSd) was observed after the LBBP operation for 1 month (153.2 ± 1.7 vs. 111.9 ± 2.6 ms, p < 0.01). LBB capture threshold and R-wave amplitude remained stable at 12-month follow-up when compared with implantation values (0.62 ± 0.13 V @ 0.4 ms vs. 0.73 ± 0.21 V @ 0.4 ms, 12.02 ± 5.68 mV vs. 8.58 ± 4.09 mV, respectively). LVEF increased significantly (35.28 ± 1.70% vs. 51.09 ± 1.71%, p < 0.01) accompanied with reduced left ventricular end-diastolic dimension (LVEDd; 65.3 ± 1.99 vs. 53.58 ± 2.07 mm, p < 0.01) and left atrial dimension (LAD; 49.03 ± 1.32 vs. 40.67 ± 1.58 mm, p < 0.01). Normalized LVEF (LVEF ≥ 50%) was found in 70.5% of patients at 12 months. The NYHA classification, brain natriuretic peptide (BNP), and 6-minute walk test (6MWT) were significantly improved at follow-up of 12 months (all p < 0.01 vs. baseline). No deaths or heart failure hospitalizations were observed during the follow-up period. CONCLUSION: The current work suggested that LBBP was feasible with a high success implantation rate and effective to correct LBBB and improved left ventricular structure and function with a low and stable pacing threshold. |
format | Online Article Text |
id | pubmed-9445246 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-94452462022-09-07 Cardiac resynchronization therapy in heart failure patients by using left bundle branch pacing Gu, Ying Li, Yanming Zhu, Ying Lin, Xiuyu Tian, Tian Zhang, Qigao Gong, Jianbin Wang, Lei Li, Jianhua Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Left bundle branch pacing (LBBP) is emerging as an effective alternative to achieve cardiac resynchronization therapy (CRT) and improve heart function. The purpose of our study was to investigate the feasibility and efficacy of LBBP in heart failure patients with left ventricular ejection fraction (LVEF) <50% and left bundle branch block (LBBB). METHODS: All patients with complete LBBB and LVEF <50% were retrospectively included in the study from April 2018 to April 2021 and underwent CRT via LBBP implantation. ECG, pacing parameters, the New York Heart Association (NYHA) functional class, echocardiographic measurements, and complications were recorded and analyzed at implant and during follow-up of 1, 6, and 12 months. RESULTS: Left bundle branch pacing was successful in all 34 patients (mean age 65.6 ± 11.2 years, 67.6% men). A significant decrease in QRS duration (QRSd) was observed after the LBBP operation for 1 month (153.2 ± 1.7 vs. 111.9 ± 2.6 ms, p < 0.01). LBB capture threshold and R-wave amplitude remained stable at 12-month follow-up when compared with implantation values (0.62 ± 0.13 V @ 0.4 ms vs. 0.73 ± 0.21 V @ 0.4 ms, 12.02 ± 5.68 mV vs. 8.58 ± 4.09 mV, respectively). LVEF increased significantly (35.28 ± 1.70% vs. 51.09 ± 1.71%, p < 0.01) accompanied with reduced left ventricular end-diastolic dimension (LVEDd; 65.3 ± 1.99 vs. 53.58 ± 2.07 mm, p < 0.01) and left atrial dimension (LAD; 49.03 ± 1.32 vs. 40.67 ± 1.58 mm, p < 0.01). Normalized LVEF (LVEF ≥ 50%) was found in 70.5% of patients at 12 months. The NYHA classification, brain natriuretic peptide (BNP), and 6-minute walk test (6MWT) were significantly improved at follow-up of 12 months (all p < 0.01 vs. baseline). No deaths or heart failure hospitalizations were observed during the follow-up period. CONCLUSION: The current work suggested that LBBP was feasible with a high success implantation rate and effective to correct LBBB and improved left ventricular structure and function with a low and stable pacing threshold. Frontiers Media S.A. 2022-08-23 /pmc/articles/PMC9445246/ /pubmed/36082131 http://dx.doi.org/10.3389/fcvm.2022.990016 Text en Copyright © 2022 Gu, Li, Zhu, Lin, Tian, Zhang, Gong, Wang and Li. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Gu, Ying Li, Yanming Zhu, Ying Lin, Xiuyu Tian, Tian Zhang, Qigao Gong, Jianbin Wang, Lei Li, Jianhua Cardiac resynchronization therapy in heart failure patients by using left bundle branch pacing |
title | Cardiac resynchronization therapy in heart failure patients by using left bundle branch pacing |
title_full | Cardiac resynchronization therapy in heart failure patients by using left bundle branch pacing |
title_fullStr | Cardiac resynchronization therapy in heart failure patients by using left bundle branch pacing |
title_full_unstemmed | Cardiac resynchronization therapy in heart failure patients by using left bundle branch pacing |
title_short | Cardiac resynchronization therapy in heart failure patients by using left bundle branch pacing |
title_sort | cardiac resynchronization therapy in heart failure patients by using left bundle branch pacing |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9445246/ https://www.ncbi.nlm.nih.gov/pubmed/36082131 http://dx.doi.org/10.3389/fcvm.2022.990016 |
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