Feasibility and efficacy of left bundle branch area pacing in patients indicated for cardiac resynchronization therapy
Feasibility and efficacy of left bundle branch area pacing in patients indicated for cardiac resynchronization therapy
复制标题
左束支区域起搏在心脏再同步治疗患者中的可行性和有效性
DOI：
10.1093/europace/euaa271
复制
发表时间：
2020-12-01
期刊：
影响因子：
6.1
通讯作者：
Zhang, Shu
中科院分区：
文献类型：
--
作者：
Li, Yuqiu;Yan, Lirong;Zhang, Shu
目的探讨左束支区域起搏(LBBAP)在心脏再同步治疗(CRT)患者中应用的可行性和临床效果。方法与结果25例患者采用LBBAP治疗，其中5例为左室导联置入失败患者的抢救策略，其余20例为主要抢救策略。在植入和随访时评估起搏参数、起搏程序特征、心电图和超声心动图数据。25例CRT患者中，左束支传导阻滞14例(56.0%)，右束支传导阻滞3例(12.0%)，室内传导延迟4例(16.0%)，起搏依赖4例(16.0%)。下体BAP显著缩短QRS间期(固有163.6+/-29.4ms比下体BAP 123.0+/-10.8ms，P<0.001)。在9.1个月的平均随访期间，纽约心脏协会功能分级从基线的2.6+/-0.6(P<；0.001)提高到1.4+/-0.6(P<；0.001)，左心室射血分数从基线的35.2+/-7.0%增加到46.9+/-10.2%(P<；0.001)，左心室舒张末内径从基线的64.1+/-9.9 mm下降到56.8+/-9.7 mm(P<；0.001)。LBBB患者左心室射血分数较治疗前明显改善(34.1+/-7.4%vs.50.0+/-12.2%，P<；0.001)。左束支区起搏导致QRSd变窄，逆转左室重构，心功能改善。对于LV导联放置失败的患者，LBBAP可能是CRT的替代选择，而对于有LBBB和心力衰竭的患者，LBBAP可能是一线选择。
Aims The present study was to evaluate the feasibility and clinical outcomes of left bundle branch area pacing (LBBAP) in cardiac resynchronization therapy (CRT)-indicated patients.Methods and results LBBAP was performed via transventricular septal approach in 25 patients as a rescue strategy in 5 patients with failed left ventricular (LV) lead placement and as a primary strategy in the remaining 20 patients. Pacing parameters, procedural characteristics, electrocardiographic, and echocardiographic data were assessed at implantation and follow-up. Of 25 enrolled CRT-indicated patients, 14 had left bundle branch block (LBBB, 56.0%), 3 right bundle branch block (RBBB, 12.0%), 4 intraventricular conduction delay (IVCD, 16.0%), and 4 ventricular pacing dependence (16.0%). The QRS duration (QRSd) was significantly shortened by LBBAP (intrinsic 163.6 +/- 29.4 ms vs. LBBAP 123.0 +/- 10.8 ms, P < 0.001). During the mean follow-up of 9.1 months, New York Heart Association functional class was improved to 1.4 +/- 0.6 from baseline 2.6 +/- 0.6 (P < 0.001), left ventricular ejection fraction (LVEF) increased to 46.9 +/- 10.2% from baseline 35.2 +/- 7.0% (P < 0.001), and LV end-diastolic dimensions (LVEDD) decreased to 56.8 +/- 9.7mm from baseline 64.1 +/- 9.9mm (P < 0.001). There was a significant improvement (34.1 +/- 7.4% vs. 50.0 +/- 12.2%, P < 0.001) in LVEF in patients with LBBB.Conclusion The present study demonstrates the clinical feasibility of LBBAP in CRT-indicated patients. Left bundle branch area pacing generated narrow QRSd and led to reversal remodelling of LV with improvement in cardiac function. LBBAP may be an alternative to CRT in patients with failure of LV lead placement and a first-line option in selected patients such as those with LBBB and heart failure.