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Left bundle branch area. A new site for physiological pacing: a pilot study

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Abstract

Chronic RV pacing may lead to pacing induced cardiomyopathy in some patients and results in a higher risk of development of LV systolic dysfunction, heart failure, mitral regurgitation and atrial fibrillation. His bundle pacing emerged as the most physiologic form of ventricular pacing. However, wide adoption of this technique in routine clinical practice is limited by higher capture thresholds at implant sometimes, lower R wave amplitudes, atrial over sensing and increased risk for late rise in pacing thresholds (resulting in the need for lead revisions). Some recent studies have focused on left bundle branch area pacing as a solution to these problems. In our study, we have compared left bundle branch area pacing (in 22 patients) with conventional right ventricular apical pacing (in 28 patients) who presented to us with conventional indications for pacemaker implantations in term of procedure and fluoroscopy time and short-term lead performance and left ventricular function. The results of our study showed that left bundle branch area pacing is associated with shortened QRS duration (22.36 ± 9.36 ms) and better LV function (higher left ventricular ejection fraction 64.00 ± 3.03 vs. 59.73 ± 6.73 with a p value of 0.013 and lower left ventricular diastolic internal diameter 4.58 ± 0.32 vs. 5.23 ± 0.40 cm with a p value of < 0.001) in comparison to right ventricular apical pacing. The total procedure time and fluoroscopy time was similar (63.15 ± 7.02 vs. 55.15 ± 6.16 min, p value 0.142 and 6.08 ± 1.42 vs. 5.06 ± 1.30 min, p value 0.332 respectively) in left bundle branch area pacing group. The results of this study indicate that left bundle branch area pacing may be an option for physiological pacing in patients requiring a high percentage of ventricular pacing.

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References

  1. Lamas GA, Lee KL, Sweeney MO, Silverman R, Leon A, Yee R, Marinchak RA, Flaker G, Schron E, Orav EJ, Hellkamp AS, Greer S, McAnulty J, Ellenbogen K, Ehlert F, Freedman RA, Estes NA 3rd, Greenspon A, Goldman L (2002) Mode selection trial in sinus-node dysfunction. Ventricular pacing or dual chamber pacing for sinus node dysfunction. N Engl J Med 346:1854–1862

    Article  Google Scholar 

  2. Yu CM, Chan JY, Zhang Q, Omar R, Yip GW, Hussin A, Fang F, Lam KH, Chan HC, Fung JW (2009) Biventricular pacing in patients with bradycardia and normal ejection fraction. N Engl J Med 361:2123–2134

    Article  Google Scholar 

  3. Merchant FM, Mittal S (2020) Pacing induced cardiomyopathy. J Cardiovasc Electrophysiol 31(1):286–292

    Article  Google Scholar 

  4. Merchant FM, Mittal S (2018) Pacing-induced cardiomyopathy. Card Electrophysiol Clin 10(3):437–445

    Article  Google Scholar 

  5. Sharma PS, Dandamudi G, Naperkowski A, Oren JW, Storm RH, Ellenbogen KA, Vijayaraman P (2015) Permanent His-bundle pacing is feasible, safe, and superior to right ventricular pacing in routine clinical practice. Heart Rhythm 12:305–312

    Article  Google Scholar 

  6. Abdelrahman M, Subzposh FA, Beer D, Durr B, Naperkowski A, Sun H, Oren JW, Dandamudi G, Vijayaraman P (2018) Clinical outcomes of His bundle pacing compared to right ventricular pacing. J Am Coll Cardiol 71:2319–2330

    Article  Google Scholar 

  7. Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD (2019) 2018 ACC/AHA/HRS Guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: executive summary: a report of the American College of Cardiology/American heart association task force on clinical practice guidelines, and the heart rhythm society. J Am Coll Cardiol 74(7):932–987

    Article  Google Scholar 

  8. Bhatt AG, Musat D, Milstein N, Pimienta J, Flynn L, Sichrovsky T, Preminger MW, Mittal S (2018) The efficacy of His bundle pacing: lessons learned from implementation for the first time at an experienced electrophysiology center. JACC Clin Electrophysiol 4:1397–1406

    Article  Google Scholar 

  9. Vijayaraman P, Dandamudi G, Zanon F, Tung R, Huang W, Sharma P, Koneru J, Tada H, Ellenbogen KA, Lustgarten DL (2018) Permanent his bundle pacing (HBP): recommendations from international HBP collaborative group for standardization of definitions, implant measurements and follow-up. Heart Rhythm 15:460–468

    Article  Google Scholar 

  10. Zanon F, Ellenbogen KA, Dandamudi G, Sharma PS, Huang W, Lustgarten DL, Tung R, Tada H, Koneru JN, Bergemann T, Fagan DH, Hudnall JH, Vijayaraman P (2018) Permanent His-bundle pacing: a systematic literature review and meta-analysis. Europace 20:1819–1826

    Article  Google Scholar 

  11. Vijayaraman P, Naperkowski A, Subzposh FA, Abdelrahman M, Sharma P, Oren JW, Dandamudi G, Ellenbogen KA (2018) Permanent His bundle pacing: long-term lead performance and clinical outcomes. Heart Rhythm 15:696–702

    Article  Google Scholar 

  12. Huang W, Su L, Wu S, Xu L, Xiao F, Zhou X, Ellenbogen KA (2017) A novel pacing strategy with low and stable output: pacing the left bundle branch immediately beyond the conduction block. Can J Cardiol 33(12):1736.e1–1736.e3

    Article  Google Scholar 

  13. Vijayaraman P, Subzposh FA, Naperkowski A, Panikkath R, John K, Mascarenhas V, Bauch TD, Huang W (2019) Prospective evaluation of feasibility, electrophysiologic and echocardiographic characteristics of left bundle branch area pacing. Heart Rhythm 16(12):1774–1782

    Article  Google Scholar 

  14. Tawara S (1906) Das Reizleitungssystem des Saügetierherzens. Jena: Gustav Fischer; 135–138 [149].

  15. Hudson REB (1967) Surgical pathology of the conducting system of the heart. Br Heart J 29:646–670

    Article  CAS  Google Scholar 

  16. RosenbaumMB, ElizariMV, Lázzari JO (1968) Los hemibloqueos. Ed Paidos 742.

  17. Rosenbaum MB, Elizari MV, Lázzari JO. The Hemiblocks (1970) New concepts of intraventricular conduction based on human, anatomical and clinical studies. Tampa Tracings; 269 [Olsmar, Fla].

  18. Vijayaraman P, Huang W (2019) Atrio-ventricular block at the distal His bundle: electrophysiologic insights from left bundle branch pacing. Heart Rhythm Case Reports 5:233–236

    Article  Google Scholar 

  19. Kaye GC, Linker NJ, Marwick TH, Pollock L, Graham L, Pouliot E, Poloniecki J, Gammage M, Protect-Pace trial investigators (2015) Effect of right ventricular pacing lead site on left ventricular function in patients with high-grade atrio-ventricular block: results of the Protect-Pace study. Eur Heart J 36(14):856–862

    Article  Google Scholar 

  20. Das A, Kahali D (2018) Ventricular septal pacing: optimum method to position the lead. Indian Heart J 70(5):713–720

    Article  Google Scholar 

  21. Tops LF, Schalij MJ, Bax JJ (2009) The effects of right ventricular apical pacing on ventricular function and dyssynchrony. J Am Coll Cardiol 54:764–776

    Article  Google Scholar 

  22. Blanc JJ, Etienne Y, Gilard M, Mansourati J, Munier S, Jacques (1997) Evaluation of different ventricular pacing sites in patients with severe heart failure. Circulation 96:3273–3277

    Article  CAS  Google Scholar 

  23. Buckingham TA, Candinas R, Duru F, Pagotto E, Schönbeck M, Amann FW, Turina M, Schmid ER (1999) Acute hemodynamic effects of alternate and combined site pacing in patients after cardiac surgery. Pacing Clin Electrophysiol 22:887–893

    Article  CAS  Google Scholar 

  24. Kypta A, Steinwender C, Kammler J, Leisch F, Hofmann R (2008) Long-term outcomes in patients with atrioventricular block undergoing septal ventricular lead implantation compared with standard apical pacing. Europace 10:574–579

    Article  Google Scholar 

  25. Vanerio G, Vidal JL, Fernández Banizi P, Banina Aguerre D, Viana P, Tejada J (2008) Medium- and long-term survival after pacemaker implant: improved survival with right ventricular outflow tract pacing. J Int Cardiac Electrophysiol 21:195–201

    Article  Google Scholar 

  26. Hussain MA, Furuya-kanamori L, Kaye G, Clark J, Doi SAR (2015) The effect of right ventricular apical and nonapical pacing on the short- and long-term changes in left ventricular ejection fraction: a systematic review and meta-analysis of randomized-controlled trials. PACE 38(9):1121–1136

    Article  Google Scholar 

  27. Pang BJ, Joshi SB, Lui EH, Tacey MA, Ling LH, Alison J, Seneviratne SK, Cameron JD, Mond HG (2014) Validation of conventional fluoroscopic and ECG criteria for right ventricular pacemaker lead position using cardiac computed tomography. Pacing Clin Electrophysiol 37(4):495–504

    Article  Google Scholar 

  28. Das A, Chatterjee S (2019) Feasibility of RA-LV pacing in patients with symptomatic left bundle branch block: a pilot study. Heart Vessels 34(9):1552–1558

    Article  Google Scholar 

  29. Vijayaraman P, Bordachar P, Ellenbogen KA (2017) The continued search for physiological pacing: where are we now? J Am Coll Cardiol 69:3099–3114

    Article  Google Scholar 

  30. Deshmukh P, Casavant DA, Romanyshyn M, Anderson K (2000) Permanent, direct Hisbundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. Circulation 101:869–877

    Article  CAS  Google Scholar 

  31. Zanon F, Baracca E, Aggio S, Pastore G, Boaretto G, Cardano P, Marotta T, Rigatelli G, Galasso M, Carraro M, Zonzin P (2006) A feasible approach for direct his-bundle pacing using a new steerable catheter to facilitate precise lead placement. J Cardiovasc Electrophysiol 17:29–33

    PubMed  Google Scholar 

  32. Lustgarten DL, Calame S, Crespo EM, Calame J, Lobel R, Spector PS, Lustgarten DL, Crespo EM, Arkhipova-Jenkins I, Lobel R, Winget J, Koehler J, Liberman E, Sheldon T, Metrics PX (2015) His-bundle pacing versus biventricular pacing in cardiac resynchronization therapy patients: a crossover design comparison. Heart Rhythm 12:1548–1557

    Article  Google Scholar 

  33. Zhang JM, Wang Z, Cheng L, Zu L, Liang Z, Hang F, Wang X, Li X, Su R, Du J, Wu Y (2019) Immediate clinical outcomes of left bundle branch area pacing vs conventional right ventricular pacing. Clin Cardiol 42(8):768–773

    PubMed  PubMed Central  Google Scholar 

  34. Li X, Li H, Ma W, Ning X, Liang E, Pang K, Yao Y, Hua W, Zhang S, Fan X (2019) Permanent left bundle branch area pacing for atrio-ventricular block: Feasibility, safety, and acute effect. Heart Rhythm 16:1766–1773

    Article  Google Scholar 

  35. Vijayaraman P, Huang W (2019) Atrioventricular block at the distal His bundle: electrophysiological insights from left bundle branch pacing. HeartRhythm Case Rep 5(4):233–236

    Article  Google Scholar 

  36. Jastrzębski M, Moskal P, Bednarek A, Kiełbasa G, Kusiak A, Sondej T, Bednarski A, Vijayaraman P, Czarnecka D (2020) Programmed deep septal stimulation: a novel maneuver for the diagnosis of left bundle branch capture during permanent pacing. J Cardiovasc Electrophysiol 31(2):485–493

    Article  Google Scholar 

  37. Chen K, Li Y, Dai Y, Sun Q, Luo B, Li C, Zhang S (2019) Comparison of electrocardiogram characteristics and pacing parameters between left bundle branch pacing and right ventricular pacing in patients receiving pacemaker therapy. Europace 21(4):673–680

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, IPGME&R and SSKM Hospital, 244, AJC Bose Road, Kolkata, 700020, India

    Asit Das, Sk Sahidul Islam, Sushant Kumar Pathak, Ishita Majumdar, Shah Alam Sharwar & Ranita Saha

  2. B.M Birla Heart Research Centre, Kolkata, India

    Suman Chatterjee

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  1. Asit Das
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  2. Sk Sahidul Islam
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  3. Sushant Kumar Pathak
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Correspondence to Asit Das.

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Das, A., Islam, S.S., Pathak, S.K. et al. Left bundle branch area. A new site for physiological pacing: a pilot study. Heart Vessels 35, 1563–1572 (2020). https://doi.org/10.1007/s00380-020-01623-y

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