International Heart Journal

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Volume 62 (2021) Issue 1 Pages 78-86

Electrophysiological Insights into Three Modalities of Left Bundle Branch Area Pacing in Patients Indicated for Pacing Therapy

Jiefang Zhang, Xia Sheng, Yiwen Pan, Min Wang, Guosheng Fu

Left bundle branch pacing (LBBP) has been adopted as a new pacing therapy whether in routine pacing or patients with heart failure, but the criteria for a completely captured LBBP are too complicated and have a low success rate in routine clinical practice.

Consecutive patients with pacing therapy indications were enrolled. Left bundle branch area pacing (LBBAP) was conducted, and the presence of LBB potential, paced QRS duration, stimulus to left ventricular activation time (Stim-LVAT), and LBB potential to left ventricular activation time (LBB po-LVAT) were determined and utilized to characterize LBBAP modalities. Pacing parameters and safety were assessed at 6-month follow-up. LBBAP succeeded in 95.6% of patients (103/106) who completed the 6-month follow-up. Complete LBBP was achieved in 21 (20%) patients, characterized with a short Stim-LVAT equal to LBB po-LVAT. Incomplete LBBP was achieved in 58 (56%) patients with a short Stim-LVAT equal to LBB po-LVAT at a high pacing output and a relatively longer Stim-LVAT at a low pacing output. Deep septal pacing (DSP) characterized with no LBB potential and a longer Stim-LVAT (83.3 ± 7.7 ms) than that in LBBP (71.37 ± 7.1 ms, P < 0.01 versus DSP) was observed in 24 (23%) patients. Complete LBBP had a longer total procedure time and longer fluoroscopic time than the other two groups.

This study describes the similarities and differences in electrophysiological characteristics and the possible mechanisms of the different types of LBBAP, classified into 3 modalities in routine clinical practice, each with narrow paced QRS duration and stable parameters, indicating LBBAP can be a near-physiological pacing modality.

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2021 Volume 62 Issue 1

Silence Is Golden Menghui Liu, Yingjie Guo, Jingzhou Jiang, Xinxue Liao, Lichun Wang
Intravenous Mineralocorticoid Receptor Antagonist Use in Acutely Decompensated Heart Failure with Diuretic Resistance Nicolas Girerd, Matthieu Aubry, Pierre Lantelme, Olivier Huttin, Patrick Rossignol
Mid-Aortic Syndrome in Williams-Beuren Syndrome with an Atypical Small-Sized Deletion of Chromosome 7q11.23 Misdiagnosed as Takayasu Arteritis Jeong Tae Byoun, Jae Young Cho, Kyeong Ho Yun, Sang Jae Rhee, Seung Taek Yu, Su Jin Oh
Identification of SLED1 as a Potential Predictive Biomarker and Therapeutic Target of Post-Infarct Heart Failure by Bioinformatics Analyses Jiajia Zhang, Jun Wang, Yong Wu, Wei Li, Kaizheng Gong, Pei Zhao

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