Long-Term Safety and Feasibility of Left Bundle Branch Pacing in a Large Single-Center Study
Long-Term Safety and Feasibility of Left Bundle Branch Pacing in a Large Single-Center Study
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DOI：
10.1161/circep.120.009261
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发表时间：
2021-02-01
影响因子：
8.4
通讯作者：
Huang, Weijian
中科院分区：
文献类型：
--
作者：
Su, Lan;Wang, Songjie;Huang, Weijian
背景：左束支分支起搏（LBBP）是一种新型起搏方法，在之前的小型短期研究中观察到其起搏阈值较低且稳定。本研究的目的是评估LBBP的可行性和安全性，在一个大的连续的不同组的患者长期follows.Methods：本研究前瞻性地纳入了632例连续起搏器患者尝试LBBP从2017年4月至2019年7月。起搏参数，并发症，心电图和超声心动图测量进行了评估，在植入和随访期间的1，6，12，和24 months.Results：LBBP是成功的618/632（97.8%）患者根据严格的标准LBB捕获。平均随访时间为18.6 ± 6.7个月。231例患者随访超过2年。植入时的LBB夺获阈值在0.5 ms时为0.65 +/- 0.27 mV，2年随访时在0.5 ms时为0.69 +/- 0.24 mV。左束支分支传导阻滞患者的QRS时限显着缩短（167.22 +/- 18.99 vs 124.02 +/- 24.15 ms，P= 120 ms（48.82 +/- 17.78% vs 58.12 +/-13.04%，6例患者（1%）P3 V或束捕获丢失，其中2例传导系统失夺获。两名患者需要铅修订由于dislocation.Conclusions：这个大型的观察性研究表明，LBBP是可行的，在长期随访的成功率高，并发症发生率低。因此，LBBP似乎是心动过缓或心力衰竭起搏适应症患者生理起搏的可靠方法。
Background:Left bundle branch pacing (LBBP) is a novel pacing method and has been observed to have low and stable pacing thresholds in prior small short-term studies. The objective of this study was to evaluate the feasibility and safety of LBBP in a large consecutive diverse group of patients with long-term follow-up.Methods:This study prospectively enrolled 632 consecutive pacemaker patients with attempted LBBP from April 2017 to July 2019. Pacing parameters, complications, ECG, and echocardiographic measurements were assessed at implant and during follow-up of 1, 6, 12, and 24 months.Results:LBBP was successful in 618/632 (97.8%) patients according to strict criteria for LBB capture. Mean follow-up time was 18.6 +/- 6.7 months. Two hundred thirty-one patients had follow-up over 2 years. LBB capture threshold at implant was 0.65 +/- 0.27 mV at 0.5 ms and 0.69 +/- 0.24 mV at 0.5 ms at 2-year follow-up. A significant decrease in QRS duration was observed in patients with left bundle branch block (167.22 +/- 18.99 versus 124.02 +/- 24.15 ms, P= 120 ms (48.82 +/- 17.78% versus 58.12 +/- 13.04%, P3 V or loss of bundle capture in 6 patients (1%), 2 patients of them had a loss of conduction system capture. Two patients required lead revision due to dislodgement.Conclusions:This large observational study suggests that LBBP is feasible with high success rates and low complication rates during long-term follow-up. Therefore, LBBP appears to be a reliable method for physiological pacing for patients with either a bradycardia or heart failure pacing indication.