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The electrocardiogram characteristics and pacing parameters of permanent left bundle branch pacing: a systematic review and meta-analysis
Journal of Interventional Cardiac Electrophysiology ( IF 1.8 ) Pub Date : 2021-06-26 , DOI: 10.1007/s10840-021-01000-3
Jia Gao 1, 2 , Bing-Hang Zhang 3 , Nan Zhang 2 , Meng Sun 2 , Rui Wang 2
Affiliation  

Purpose

Recent advances in conduction system pacing have led to the use of left bundle branch pacing (LBBP), which has potential advantages over His bundle pacing (HBP). For example, LBBP engages the electrical activation through the left bundle branch, produces ventricular electrical synchrony, and avoids the weakness of HBP such as lead instability, higher threshold, and early battery depletion. This pacing modality has been considered an attractive mode to achieve normal physiological pacing. However, as a new technology, LBBP is still in the stage of clinical exploration and lacks adequate evaluation. This study aims to investigate the electrocardiogram characteristics, pacing parameters, the safety, and the effectiveness of LBBP.

Methods

A computerized search of PubMed, Embase, and The Cochrane Library for the effects of LBBP was done. The baseline characteristics of patients, successful rate of implantation, capture threshold, R-wave amplitude, pacing impedance, QRS duration, and follow-up date were extracted and summarized.

Results

Thirteen studies including 712 patients were included in this analysis. The overall successful rate for implantation was 92.9%. The main indications for LBBP were atrioventricular block (AVB), sinus node dysfunction (SND), atrial fibrillation (AF) with slow ventricular rate, and cardiac resynchronization therapy (CRT) candidates. For patients with QRS duration>120 ms, permanent LBBP resulted in narrower QRS duration compared to that before implantation (P = 0.05). QRS duration and capture threshold of LBBP remained stable during follow-up. Moreover, there was higher R-wave amplitude and lower pacing impedance at follow-up compared to those at implantation (P = 0.01 and P < 0.00001, respectively).

Conclusions

Permanent LBBP has shown promising results for pacemaker-indicated patients in small observational studies. Good electrical synchronization, high success rates, and stable pacemaker lead parameters suggested significant advantages of LBBP in physiological pacing. Randomized controlled trials are needed to assess the efficacy of LBBP in patients.



中文翻译:

永久性左束支起搏的心电图特征和起搏参数:系统评价和荟萃分析

目的

传导系统起搏的最新进展导致使用左束支起搏 (LBBP),它比希氏束起搏 (HBP) 具有潜在优势。例如,LBBP 通过左束支进行电激活,产生心室电同步,并避免了 HBP 的弱点,如导联不稳定、阈值较高和早期电池耗尽。这种起搏方式被认为是实现正常生理起搏的一种有吸引力的方式。然而,作为一项新技术,LBBP仍处于临床探索阶段,缺乏足够的评价。本研究旨在探讨LBBP的心电图特征、起搏参数、安全性和有效性。

方法

对 PubMed、Embase 和 Cochrane 图书馆进行了计算机搜索,以了解 LBBP 的影响。提取并总结患者的基线特征、植入成功率、捕获阈值、R波幅值、起搏阻抗、QRS波时长、随访日期。

结果

这项分析包括 13 项研究,包括 712 名患者。总体植入成功率为92.9%。LBBP 的主要适应症是房室传导阻滞 (AVB)、窦房结功能障碍 (SND)、心房颤动 (AF) 伴心室率减慢和心脏再同步化治疗 (CRT) 候选者。对于 QRS 持续时间>120 ms 的患者,与植入前相比,永久性 LBBP 导致 QRS 持续时间更窄(P  = 0.05)。随访期间 LBBP 的 QRS 持续时间和捕获阈值保持稳定。此外,与植入时相比,随访时 R 波振幅更高,起搏阻抗更低(分别为P  = 0.01 和P  < 0.00001)。

结论

在小型观察性研究中,永久性 LBBP 对起搏器指示的患者显示出有希望的结果。良好的电同步、高成功率和稳定的起搏器导联参数表明 LBBP 在生理起搏中具有显着优势。需要随机对照试验来评估 LBBP 在患者中的疗效。

更新日期:2021-06-28
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