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Erschienen in:
21.09.2020
Comparison between his-bundle pacing and left bundle branch pacing in patients with atrioventricular block
Erschienen in: Journal of Interventional Cardiac Electrophysiology | Ausgabe 1/2021
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Background
Pacing the cardiac conduction system has been explored in patients with conduction system disease, but comprehensive comparisons between different pacing modalities are not well investigated.
Objective
To compare pacing characteristics and ventricular synchrony between His-bundle pacing (HBP) and left bundle branch pacing (LBBP) in patients with atrioventricular block (AVB).
Methods
Fifty pacemaker-indicated patients with AVB were enrolled. Twenty-five patients underwent HBP, and another 25 patients underwent LBBP. Success rate, procedural and fluoroscopy duration, pacing parameters, and echocardiographic data were perioperatively assessed and at 3-month follow-up.
Results
HBP was successful in 19 of 25 (76.0%) patients, whereas LBBP was successful in 22 of 25 (88.0%) patients. Compared with HBP, LBBP capture threshold was significantly lower (0.76 ± 0.25 V/0.4 ms vs. 1.27 ± 0.61 V/1.0 ms, P = 0.003) and R-wave amplitude was significantly higher with LBBP (11.7 ± 6.6 vs. 4.9 ± 2.4 mV, P < 0.001) at implant. The mean procedural time (74.3 ± 17.8 vs. 63.2 ± 12.3 min, P = 0.029) and fluoroscopy duration (10.3 ± 4.5 vs. 6.8 ± 2.2 min, P = 0.005) were significantly longer in the HBP group compared to LBBP. At 3-month follow-up, pacing capture threshold remained more stable in LBBP than in HBP group while left ventricular synchrony was similar between both groups.
Conclusion
Despite similar impact on ventricular synchrony compared with HBP, LBBP featured a significantly lower pacing capture threshold, higher R-wave amplitude, and less time to achieve similar success rate in patients with AVB. These findings indicate LBBP as a physiological pacing strategy for AVB patients.