Cardiac resynchronization therapy(CRT)reduces heart failure(HF)hospitaliz-ations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch(LBB)block.Biventricular pacing(BVP)is...Cardiac resynchronization therapy(CRT)reduces heart failure(HF)hospitaliz-ations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch(LBB)block.Biventricular pacing(BVP)is considered the gold standard for achieving CRT;however,approximately 30%–40%of patients do not respond to BVP-CRT.Recent studies have demonstrated that LBB pacing(LBBP)produces remarkable results in CRT.In this meta-analysis,LBBP-CRT showed better outcomes than conventional BVP-CRT,including greater QRS duration reduction and left ventricular ejection fraction improvement,along with consistently lower pacing thresholds on follow-up.Additionally,there was a grea-ter reduction in New York Heart Association class and brain natriuretic peptide levels.This study contributes to the growing body of encouraging data on LBBP-CRT from recent years.With ongoing technological advancements and increasing operator expertise,the day may not be far when LBBP-CRT becomes the standard of care rather than the exception.展开更多
BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore...BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.展开更多
Background The study was to access the feasibility and effectiveness of permanent left bundle branch pacing(LBBP)in patients with bradycardia after cardiac surgery,in comparison with conventional right ventricular out...Background The study was to access the feasibility and effectiveness of permanent left bundle branch pacing(LBBP)in patients with bradycardia after cardiac surgery,in comparison with conventional right ventricular outflow tract septal pacing(RVOSP).Methods A total of 50 patients with cardiac surgery who underwent permanent pacemaker implantation(PPI)were enrolled,21 patients underwent LBBP(LBBP group)and 29 patients underwent RVOSP(RVOSP group).Pacing electrical parameters,QRS duration(QRSd),echocardiographic measurements,lead and device related complications were obtained at procedure and during follow-ups.Results There were no statistically significant differences between the LBBP group and the RVOSP group at procedure and at the twelfth month’s follow-up in pacing thresholds(0.64±0.16 V vs.0.63±0.22 V)and(0.91±0.28 V vs.0.85±0.20 V),R-wave amplitude(16.68±4.52 mV vs.15.09±4.53 mV)and(14.41±8.65 mV vs.12.65±6.17 mV),pacing impedances(719.24±152.65Ωvs.639.13±177.04Ω)and(534.01±96.92Ωvs.499.18±77.87Ω).But the average ventricular pacing percentage(VP%)at the first month’s follow-up(81.96±32.06%vs.58.37±42.96%)and at the twelfth month’s follow-up(84.65±35.84%vs.53.57±38.47%)showed significant difference between two groups(P<0.05);The LBBP group produced narrower QRSd(121.13±23.91 ms)than the RVOSP group(158.00±9.69 ms)(P=0.011).There were no significant differences between the LBBP group and the RVOSP group at pre-procedure and at the twelfth month’s follow-up in echocardiographic parameters,which included left ventricular end-diastolic dimension(LVEDD)(48.76±7.08 mm vs.47.34±6.91 mm)and(50.58±10.33 mm vs.45.97±7.11 mm),left ventricular ejection fraction(LVEF)(58.33±12.64%vs.61.50±8.40%)and(55.85±16.35%vs.61.50±10.52%),and area of tricuspid regurgitation(TR)(2.79±3.65 cm2 vs.2.85±2.26 cm2)and(3.09±2.34 cm2 vs.2.95±1.92 cm2).No lead and device related complication was observed during follow-ups.Conclusions LBBP is feasible and effective in patients with bradycardia after cardiac surgery.LBBP produces narrow QRSd,which may be a preferred pacing strategy for patients after cardiac surgery.[S Chin J Cardiol 2021;22(1):13-20]展开更多
Left bundle branch pacing(LBBP)emerged as a new physiological pacing strategy during the past several years.Recent observational studies have demonstrated the advantages of LBBP,including a high success rate,stable pa...Left bundle branch pacing(LBBP)emerged as a new physiological pacing strategy during the past several years.Recent observational studies have demonstrated the advantages of LBBP,including a high success rate,stable pacing parameters,and excellent clinical benefits.Widespread adoption of LBBP will depend on improvements in device/lead technology and further verification of its efficacy in large randomized clinical trials.In this review,we summarize re-cent advancements in LBBP,including the definition and evaluation of left bundle branch capture,LBBP applications,and future directions in this growing field.展开更多
BACKGROUND Left bundle branch pacing(LBBP)is a physiological pacing method that has emerged in recent years.It is an ideal choice for patients with complete left bundle branch block who are in need of cardiac resynchr...BACKGROUND Left bundle branch pacing(LBBP)is a physiological pacing method that has emerged in recent years.It is an ideal choice for patients with complete left bundle branch block who are in need of cardiac resynchronization therapy(CRT).Moreover,LBBP is superior in maintaining physiological ventricular activation and can effectively improve heart function and quality of life in patients with pacemaker-induced cardiomyopathy.However,LBBP in pacing-dependent patients who already have cardiac dysfunction has not been well assessed.CASE SUMMARY A 69-year-old male patient presented with symptoms of chest tightness,palpitation and systolic heart failure with New York Heart Association class III for 1 mo.The 12-lead electrocardiogram showed atrial fibrillation with third-degree atrioventricular block and ventricular premature beat.Holter revealed a right bundle branch block,atrial fibrillation with third-degree atrioventricular block,frequent multifocal ventricular premature beats,Ron-T and ventricular tachycardia.The echocardiogram documented an enlarged left atrium and left ventricle and a low left ventricular ejection fraction.Coronary angiography indicated a stenosis of 30%in the middle left anterior descending artery.Apparently,a CRT-D pacemaker was the best choice for this patient according to previous findings.However,the patient was worried about the financial burden.A single-chamber pacemaker with LBBP was selected,with the plan to take amiodarone and upgrade with dual-chamber implantable cardioverter-defibrillator or CRT-D at an appropriate time.During the follow-up at 3 mo after LBBP,the patient showed an improvement in cardiac function with slight improvement in echocardiography parameters,and the New York Heart Association functional class was maintained at I.Moreover,the patient no longer suffered from chest tightness and palpitation.Holter showed decreased ventricular arrhythmia of less than 5%.CONCLUSION LBBP might be used in patients with heart failure and a high-degree atrioventricular block as an alternative to conventional CRT.展开更多
The recent systematic review and meta-analysis provided a comprehensive focus on the current state of cardiac resynchronization therapy(CRT).The authors determined the feasibility of physiological left bundle branch a...The recent systematic review and meta-analysis provided a comprehensive focus on the current state of cardiac resynchronization therapy(CRT).The authors determined the feasibility of physiological left bundle branch area pacing(LBBAP)in patients indicated for CRT through a careful analysis of trials.They found that LBBAP was associated with significant reductions in QRS duration,New York Heart Association functional class,B-type natriuretic peptide levels,and pacing thresholds as well as improvements in echocardiographic parameters compared to biventricular pacing.展开更多
Pacing-induced cardiomyopathy (PICM) resultsf rom the detrimental effect of frequent right ventricular pacing.^([1]) The diagnosis relies on a combination of pacing-associated ventricular dyschrony manifested with ECG...Pacing-induced cardiomyopathy (PICM) resultsf rom the detrimental effect of frequent right ventricular pacing.^([1]) The diagnosis relies on a combination of pacing-associated ventricular dyschrony manifested with ECG wide LBBB-pattern QRS duration and clinical assessment, imaging studies. Conduction system pacing (CSP), such as His bundle pacing (HBP)and left bundle branch pacing (LBBP), may help to prevent PICM,^([2]) but the criteria for optimal patient selection remain inadequately defined.展开更多
BACKGROUND As left bundle branch pacing(LBBP)is more like physiological pacing,LBBP has emerged as a novel pacing strategy that uses the native conduction system to improve ventricular synchronization with stable paci...BACKGROUND As left bundle branch pacing(LBBP)is more like physiological pacing,LBBP has emerged as a novel pacing strategy that uses the native conduction system to improve ventricular synchronization with stable pacing parameters.LBBP has been revealed associated with a significantly reduced risk of new-onset atrial fibrillation and heart failure compared with conventional permanent pacemaker implantation.CASE SUMMARY A 64-year-old man was admitted with a 24-h history of chest distress and shortness of breath,which continued unabated.The patient had no symptoms of chest pain,dizziness,syncope,nausea nor vomiting.There were no abnormalities found in routine examinations after admission.Twelve-lead electrocardiogram presented a result of 2:1 atrioventricular block.Coronary angiography was performed the next day and no abnormality was found.Finally,the patient agreed to received LBBP and signed the informed consent.During the process of withdrawing the Medtronic Model 3830 lead into sheath,we found the lead helix was wrapped around the chordae tendineae of the septal valve of tricuspid.Attempts to rotate the 3830 lead failed to release the lead helix from the chordae tendineae,and ultimately we used radiofrequency ablation to ablate the wrapped chordae tendineae.CONCLUSION Radiofrequency ablation effectively solved this problem without complications.It is an effective and reliable method to resolve lead winding chordae.展开更多
Objective:Physiologic cardiac pacing is a novel technique which has been largely popularized in recent decades.His bundle pacing(HBP)has been long considered the most physiologic pacing method;however,with the widespr...Objective:Physiologic cardiac pacing is a novel technique which has been largely popularized in recent decades.His bundle pacing(HBP)has been long considered the most physiologic pacing method;however,with the widespread implementation of this method,its disadvantages have become apparent.In this context,left bundle branch pacing(LBBP)-directly engaged in the His-Purkinje system-has been foreseen as the best pacing method to mimic physiologic activation patterns.This review aimed to summarize recent approaches to physiologic cardiac pacing.Data sources:This review included fully peer reviewed publications up to July 2018,found in the PubMed database using the keywords"His bundle branch pacing,""right ventricular pacing,"and"physiologic pacing."Study selection:All selected articles were in English,with no restriction on study design.Results:The HBP has been studied worldwide,and is currently considered the most physiologic pacing method.However,it has disadvantages,such as high pacing threshold,unsatisfactory sensing and long procedure times,among others.Although LBBP is theoretically superior to HBP,the clinical relevance of this difference remains under debate,as few large randomized clinical trials with LBBP have been published.Conclusions:Although HBP indeed appears to be the most physiologic pacing method,it has certain shortcomings,such as high pacing threshold,difficult implantation due to specific anatomic features,and others.Further studies are required to clarify the clinical significance of LBBP.展开更多
文摘Cardiac resynchronization therapy(CRT)reduces heart failure(HF)hospitaliz-ations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch(LBB)block.Biventricular pacing(BVP)is considered the gold standard for achieving CRT;however,approximately 30%–40%of patients do not respond to BVP-CRT.Recent studies have demonstrated that LBB pacing(LBBP)produces remarkable results in CRT.In this meta-analysis,LBBP-CRT showed better outcomes than conventional BVP-CRT,including greater QRS duration reduction and left ventricular ejection fraction improvement,along with consistently lower pacing thresholds on follow-up.Additionally,there was a grea-ter reduction in New York Heart Association class and brain natriuretic peptide levels.This study contributes to the growing body of encouraging data on LBBP-CRT from recent years.With ongoing technological advancements and increasing operator expertise,the day may not be far when LBBP-CRT becomes the standard of care rather than the exception.
文摘BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.
文摘Background The study was to access the feasibility and effectiveness of permanent left bundle branch pacing(LBBP)in patients with bradycardia after cardiac surgery,in comparison with conventional right ventricular outflow tract septal pacing(RVOSP).Methods A total of 50 patients with cardiac surgery who underwent permanent pacemaker implantation(PPI)were enrolled,21 patients underwent LBBP(LBBP group)and 29 patients underwent RVOSP(RVOSP group).Pacing electrical parameters,QRS duration(QRSd),echocardiographic measurements,lead and device related complications were obtained at procedure and during follow-ups.Results There were no statistically significant differences between the LBBP group and the RVOSP group at procedure and at the twelfth month’s follow-up in pacing thresholds(0.64±0.16 V vs.0.63±0.22 V)and(0.91±0.28 V vs.0.85±0.20 V),R-wave amplitude(16.68±4.52 mV vs.15.09±4.53 mV)and(14.41±8.65 mV vs.12.65±6.17 mV),pacing impedances(719.24±152.65Ωvs.639.13±177.04Ω)and(534.01±96.92Ωvs.499.18±77.87Ω).But the average ventricular pacing percentage(VP%)at the first month’s follow-up(81.96±32.06%vs.58.37±42.96%)and at the twelfth month’s follow-up(84.65±35.84%vs.53.57±38.47%)showed significant difference between two groups(P<0.05);The LBBP group produced narrower QRSd(121.13±23.91 ms)than the RVOSP group(158.00±9.69 ms)(P=0.011).There were no significant differences between the LBBP group and the RVOSP group at pre-procedure and at the twelfth month’s follow-up in echocardiographic parameters,which included left ventricular end-diastolic dimension(LVEDD)(48.76±7.08 mm vs.47.34±6.91 mm)and(50.58±10.33 mm vs.45.97±7.11 mm),left ventricular ejection fraction(LVEF)(58.33±12.64%vs.61.50±8.40%)and(55.85±16.35%vs.61.50±10.52%),and area of tricuspid regurgitation(TR)(2.79±3.65 cm2 vs.2.85±2.26 cm2)and(3.09±2.34 cm2 vs.2.95±1.92 cm2).No lead and device related complication was observed during follow-ups.Conclusions LBBP is feasible and effective in patients with bradycardia after cardiac surgery.LBBP produces narrow QRSd,which may be a preferred pacing strategy for patients after cardiac surgery.[S Chin J Cardiol 2021;22(1):13-20]
基金This work was supported by the National Natural Science Foundation of China(82070521)Clinical Competence Improvement Project of Jiangsu Province Hospital(JSPH-MA-2020-3)Project on New Technology of Jiangsu Province(JX233C202103).
文摘Left bundle branch pacing(LBBP)emerged as a new physiological pacing strategy during the past several years.Recent observational studies have demonstrated the advantages of LBBP,including a high success rate,stable pacing parameters,and excellent clinical benefits.Widespread adoption of LBBP will depend on improvements in device/lead technology and further verification of its efficacy in large randomized clinical trials.In this review,we summarize re-cent advancements in LBBP,including the definition and evaluation of left bundle branch capture,LBBP applications,and future directions in this growing field.
文摘BACKGROUND Left bundle branch pacing(LBBP)is a physiological pacing method that has emerged in recent years.It is an ideal choice for patients with complete left bundle branch block who are in need of cardiac resynchronization therapy(CRT).Moreover,LBBP is superior in maintaining physiological ventricular activation and can effectively improve heart function and quality of life in patients with pacemaker-induced cardiomyopathy.However,LBBP in pacing-dependent patients who already have cardiac dysfunction has not been well assessed.CASE SUMMARY A 69-year-old male patient presented with symptoms of chest tightness,palpitation and systolic heart failure with New York Heart Association class III for 1 mo.The 12-lead electrocardiogram showed atrial fibrillation with third-degree atrioventricular block and ventricular premature beat.Holter revealed a right bundle branch block,atrial fibrillation with third-degree atrioventricular block,frequent multifocal ventricular premature beats,Ron-T and ventricular tachycardia.The echocardiogram documented an enlarged left atrium and left ventricle and a low left ventricular ejection fraction.Coronary angiography indicated a stenosis of 30%in the middle left anterior descending artery.Apparently,a CRT-D pacemaker was the best choice for this patient according to previous findings.However,the patient was worried about the financial burden.A single-chamber pacemaker with LBBP was selected,with the plan to take amiodarone and upgrade with dual-chamber implantable cardioverter-defibrillator or CRT-D at an appropriate time.During the follow-up at 3 mo after LBBP,the patient showed an improvement in cardiac function with slight improvement in echocardiography parameters,and the New York Heart Association functional class was maintained at I.Moreover,the patient no longer suffered from chest tightness and palpitation.Holter showed decreased ventricular arrhythmia of less than 5%.CONCLUSION LBBP might be used in patients with heart failure and a high-degree atrioventricular block as an alternative to conventional CRT.
文摘The recent systematic review and meta-analysis provided a comprehensive focus on the current state of cardiac resynchronization therapy(CRT).The authors determined the feasibility of physiological left bundle branch area pacing(LBBAP)in patients indicated for CRT through a careful analysis of trials.They found that LBBAP was associated with significant reductions in QRS duration,New York Heart Association functional class,B-type natriuretic peptide levels,and pacing thresholds as well as improvements in echocardiographic parameters compared to biventricular pacing.
文摘Pacing-induced cardiomyopathy (PICM) resultsf rom the detrimental effect of frequent right ventricular pacing.^([1]) The diagnosis relies on a combination of pacing-associated ventricular dyschrony manifested with ECG wide LBBB-pattern QRS duration and clinical assessment, imaging studies. Conduction system pacing (CSP), such as His bundle pacing (HBP)and left bundle branch pacing (LBBP), may help to prevent PICM,^([2]) but the criteria for optimal patient selection remain inadequately defined.
文摘BACKGROUND As left bundle branch pacing(LBBP)is more like physiological pacing,LBBP has emerged as a novel pacing strategy that uses the native conduction system to improve ventricular synchronization with stable pacing parameters.LBBP has been revealed associated with a significantly reduced risk of new-onset atrial fibrillation and heart failure compared with conventional permanent pacemaker implantation.CASE SUMMARY A 64-year-old man was admitted with a 24-h history of chest distress and shortness of breath,which continued unabated.The patient had no symptoms of chest pain,dizziness,syncope,nausea nor vomiting.There were no abnormalities found in routine examinations after admission.Twelve-lead electrocardiogram presented a result of 2:1 atrioventricular block.Coronary angiography was performed the next day and no abnormality was found.Finally,the patient agreed to received LBBP and signed the informed consent.During the process of withdrawing the Medtronic Model 3830 lead into sheath,we found the lead helix was wrapped around the chordae tendineae of the septal valve of tricuspid.Attempts to rotate the 3830 lead failed to release the lead helix from the chordae tendineae,and ultimately we used radiofrequency ablation to ablate the wrapped chordae tendineae.CONCLUSION Radiofrequency ablation effectively solved this problem without complications.It is an effective and reliable method to resolve lead winding chordae.
基金a grant from the National Natural Science Foundation of Ghina(No.81570220).
文摘Objective:Physiologic cardiac pacing is a novel technique which has been largely popularized in recent decades.His bundle pacing(HBP)has been long considered the most physiologic pacing method;however,with the widespread implementation of this method,its disadvantages have become apparent.In this context,left bundle branch pacing(LBBP)-directly engaged in the His-Purkinje system-has been foreseen as the best pacing method to mimic physiologic activation patterns.This review aimed to summarize recent approaches to physiologic cardiac pacing.Data sources:This review included fully peer reviewed publications up to July 2018,found in the PubMed database using the keywords"His bundle branch pacing,""right ventricular pacing,"and"physiologic pacing."Study selection:All selected articles were in English,with no restriction on study design.Results:The HBP has been studied worldwide,and is currently considered the most physiologic pacing method.However,it has disadvantages,such as high pacing threshold,unsatisfactory sensing and long procedure times,among others.Although LBBP is theoretically superior to HBP,the clinical relevance of this difference remains under debate,as few large randomized clinical trials with LBBP have been published.Conclusions:Although HBP indeed appears to be the most physiologic pacing method,it has certain shortcomings,such as high pacing threshold,difficult implantation due to specific anatomic features,and others.Further studies are required to clarify the clinical significance of LBBP.
