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The electrocardiogram characteristics and pacing parameters of permanent left bundle branch pacing: a systematic review and meta-analysis

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Abstract

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.

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References

  1. Khurshid S, Epstein AE, Verdino RJ, Lin D, Goldberg LR, Marchlinski FE, et al. Incidence and predictors of right ventricular pacing-induced cardiomyopathy. Heart Rhythm. 2014;11(9):1619–25. https://doi.org/10.1016/j.hrthm.2014.05.040.

    Article  PubMed  Google Scholar 

  2. Hussain MA, Furuya-Kanamori L, Kaye G, Clark J, Doi SA. 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. Pacing and clinical electrophysiology : PACE. 2015;38(9):1121–36. https://doi.org/10.1111/pace.12681.

    Article  PubMed  Google Scholar 

  3. Cho SW, Gwag HB, Hwang JK, Chun KJ, Park KM, On YK, et al. Clinical features, predictors, and long-term prognosis of pacing-induced cardiomyopathy. Eur J Heart Fail. 2019;21(5):643–51. https://doi.org/10.1002/ejhf.1427.

    Article  PubMed  Google Scholar 

  4. Vijayaraman P, Bordachar P, Ellenbogen KA. The continued search for physiological pacing: where are we now? J Am Coll Cardiol. 2017;69(25):3099–114. https://doi.org/10.1016/j.jacc.2017.05.005.

    Article  PubMed  Google Scholar 

  5. Deshmukh P, Casavant DA, Romanyshyn M, Anderson K. Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. Circulation. 2000;101(8):869–77. https://doi.org/10.1161/01.cir.101.8.869.

    Article  CAS  PubMed  Google Scholar 

  6. Vijayaraman P, Naperkowski A, Subzposh FA, Abdelrahman M, Sharma PS, Oren JW, et al. Permanent His-bundle pacing: long-term lead performance and clinical outcomes. Heart Rhythm. 2018;15(5):696–702. https://doi.org/10.1016/j.hrthm.2017.12.022.

    Article  PubMed  Google Scholar 

  7. Zhang J, Guo J, Hou X, Wang Y, Qian Z, Li K, et al. Comparison of the effects of selective and non-selective His bundle pacing on cardiac electrical and mechanical synchrony. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2018;20(6):1010–7. https://doi.org/10.1093/europace/eux120.

    Article  Google Scholar 

  8. Huang W, Su L, Wu S, Xu L, Xiao F, Zhou X, et al. A novel pacing strategy with low and stable output: pacing the left bundle branch immediately beyond the conduction block. The Canadian journal of cardiology. 2017;33(12):1736.e1–3. https://doi.org/10.1016/j.cjca.2017.09.013.

    Article  Google Scholar 

  9. Zhang W, Huang J, Qi Y, Wang F, Guo L, Shi X, et al. Cardiac resynchronization therapy by left bundle branch area pacing in patients with heart failure and left bundle branch block. Heart Rhythm. 2019;16(12):1783–90. https://doi.org/10.1016/j.hrthm.2019.09.006.

    Article  PubMed  Google Scholar 

  10. Hou X, Qian Z, Wang Y, Qiu Y, Chen X, Jiang H, et al. Feasibility and cardiac synchrony of permanent left bundle branch pacing through the interventricular septum. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2019;21(11):1694–702. https://doi.org/10.1093/europace/euz188.

    Article  Google Scholar 

  11. Ponnusamy SS, Muthu G, Kumar M, Bopanna D, Anand V, Kumar S. Mid-term feasibility, safety and outcomes of left bundle branch pacing-single center experience. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. 2020;60(337):346. https://doi.org/10.1007/s10840-020-00807-w.

    Article  Google Scholar 

  12. Li X, Li H, Ma W, Ning X, Liang E, Pang K, et al. Permanent left bundle branch area pacing for atrioventricular block: feasibility, safety, and acute effect. Heart Rhythm. 2019;16(12):1766–73. https://doi.org/10.1016/j.hrthm.2019.04.043.

    Article  PubMed  Google Scholar 

  13. Guo J, Li L, Xiao G, Huang X, Li Q, Wang Y, et al. Feasibility and stability of left bundle branch pacing in patients after prosthetic valve implantation. Clin Cardiol. 2020;43(10):1110–8. https://doi.org/10.1002/clc.23413.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hasumi E, Fujiu K, Nakanishi K, Komuro I. Impacts of left bundle/peri-left bundle pacing on left ventricular contraction. Circulation journal : official journal of the Japanese Circulation Society. 2019;83(9):1965–7. https://doi.org/10.1253/circj.CJ-19-0399.

    Article  Google Scholar 

  15. Hu Y, Li H, Gu M, Hua W, Niu H, Zhang N, et al. Comparison between his-bundle pacing and left bundle branch pacing in patients with atrioventricular block. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. 2020. https://doi.org/10.1007/s10840-020-00869-w.

  16. Chen K, Li Y, Dai Y, Sun Q, Luo B, Li C, et al. Comparison of electrocardiogram characteristics and pacing parameters between left bundle branch pacing and right ventricular pacing in patients receiving pacemaker therapy. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2019;21(4):673–80. https://doi.org/10.1093/europace/euy252.

    Article  Google Scholar 

  17. Vijayaraman P, Subzposh F, Naperkowski A, Panikkath R, John K, Mascarenhas V, et al. Prospective evaluation of feasibility and electrophysiologic and echocardiographic characteristics of left bundle branch area pacing. 2019;16(12):1774–82. https://doi.org/10.1016/j.hrthm.2019.05.011.

  18. Li Y, Chen K, Dai Y, Li C, Sun Q, Chen R, et al. Left bundle branch pacing for symptomatic bradycardia: implant success rate, safety, and pacing characteristics. Heart Rhythm. 2019;16(12):1758–65. https://doi.org/10.1016/j.hrthm.2019.05.014.

    Article  PubMed  Google Scholar 

  19. Vijayaraman P, Subzposh FA, Naperkowski A, Panikkath R, John K, Mascarenhas V, et al. Prospective evaluation of feasibility and electrophysiologic and echocardiographic characteristics of left bundle branch area pacing. Heart Rhythm. 2019;16(12):1774–82. https://doi.org/10.1016/j.hrthm.2019.05.011.

    Article  PubMed  Google Scholar 

  20. Ramprakash Balasundaram D, Dm HBR, Sharada Kalavakolanu D, Calambur Narasimhan D. Ab %J Heart Rhythm. Catheter ablation of bundle branch reentrant ventricular tachycardia. 2008;5(6):S68–72.

    Google Scholar 

  21. Wu S, Su L, Wang S, Vijayaraman P, Ellenbogen KA, Huang W. Peri-left bundle branch pacing in a patient with right ventricular pacing-induced cardiomyopathy and atrioventricular infra-Hisian block. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2019;21(7):1038. https://doi.org/10.1093/europace/euz031.

    Article  Google Scholar 

  22. Ravi V, Larsen T, Ooms S, Trohman R, Sharma PS. Late-onset interventricular septal perforation from left bundle branch pacing. HeartRhythm case reports. 2020;6(9):627–31. https://doi.org/10.1016/j.hrcr.2020.06.008.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wang J, Liang Y, Wang W, Chen X, Bai J, Chen H, et al. Left bundle branch area pacing is superior to right ventricular septum pacing concerning depolarization-repolarization reserve. J Cardiovasc Electrophysiol. 2020;31(1):313–22. https://doi.org/10.1111/jce.14295.

    Article  PubMed  Google Scholar 

  24. Padala SK, KAJHRO E. Left bundle branch pacing is the best approach to physiological pacing. 2020;1(1):59–67.

    Google Scholar 

  25. Ponnusamy SS, Vijayaraman PJHCR. Aborted ST elevation myocardial infarction – an unusual complication of left bundle branch pacing. 2020

  26. Thambo JB, Bordachar P, Garrigue S, Lafitte S, Sanders P, Reuter S, et al. Detrimental ventricular remodeling in patients with congenital complete heart block and chronic right ventricular apical pacing. Circulation. 2004;110(25):3766–72. https://doi.org/10.1161/01.Cir.0000150336.86033.8d.

    Article  PubMed  Google Scholar 

  27. Saito M, Kaye G, Negishi K, Linker N, Gammage M, Kosmala W, et al. Protect-Pace investigators. Dyssynchrony, contraction efficiency and regional function with apical and non-apical RV pacing. Heart. 2015;101(8):600–8. https://doi.org/10.1136/heartjnl-2014-306990.

    Article  PubMed  Google Scholar 

  28. Mills RW, Cornelussen RN, Mulligan LJ, Strik M, Rademakers LM, Skadsberg ND, et al. Left ventricular septal and left ventricular apical pacing chronically maintain cardiac contractile coordination, pump function and efficiency. Circ Arrhythm Electrophysiol. 2009;2(5):571–9. https://doi.org/10.1161/circep.109.882910.

    Article  PubMed  Google Scholar 

  29. Tops LF, Schalij MJ, Bax JJ. The effects of right ventricular apical pacing on ventricular function and dyssynchrony implications for therapy. J Am Coll Cardiol. 2009;54(9):764–76. https://doi.org/10.1016/j.jacc.2009.06.006.

    Article  PubMed  Google Scholar 

  30. Udo EO, van Hemel NM, Zuithoff NP, Doevendans PA, Moons KG. Risk of heart failure- and cardiac death gradually increases with more right ventricular pacing. Int J Cardiol. 2015;185:95–100. https://doi.org/10.1016/j.ijcard.2015.03.053.

    Article  PubMed  Google Scholar 

  31. Zografos TA, Siontis KC, Jastrzebski M, Kutyifa V, Klein HU, Zareba W, et al. Apical vs. non-apical right ventricular pacing in cardiac resynchronization therapy: a meta-analysis. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2015;17(8):1259–66. https://doi.org/10.1093/europace/euv048.

    Article  Google Scholar 

  32. Shimony A, Eisenberg MJ, Filion KB, Amit G. Beneficial effects of right ventricular non-apical vs. apical pacing: a systematic review and meta-analysis of randomized-controlled trials. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2012;14(1):81–91. https://doi.org/10.1093/europace/eur240.

    Article  Google Scholar 

  33. Narula OS. Longitudinal dissociation in the His bundle. Bundle branch block due to asynchronous conduction within the His bundle in man. Circulation. 1977;56(6):996–1006. https://doi.org/10.1161/01.cir.56.6.996.

    Article  CAS  PubMed  Google Scholar 

  34. El-Sherif N, Amay YLF, Schonfield C, Scherlag BJ, Rosen K, Lazzara R, et al. Normalization of bundle branch block patterns by distal His bundle pacing. Clinical and experimental evidence of longitudinal dissociation in the pathologic his bundle. Circulation. 1978;57(3):473–83. https://doi.org/10.1161/01.cir.57.3.473.

    Article  CAS  PubMed  Google Scholar 

  35. Dandamudi G, Vijayaraman P. History of His bundle pacing. J Electrocardiol. 2017;50(1):156–60. https://doi.org/10.1016/j.jelectrocard.2016.09.011.

    Article  PubMed  Google Scholar 

  36. Deshmukh A, Sattur S, Bechtol T, Heckman LIB, Prinzen FW, Deshmukh P. Sequential his bundle and left ventricular pacing for cardiac resynchronization. J Cardiovasc Electrophysiol. 2020;31(9):2448–54. https://doi.org/10.1111/jce.14674.

    Article  PubMed  Google Scholar 

  37. Anderson RH, Boyett MR, Dobrzynski H, Moorman AF. The anatomy of the conduction system: implications for the clinical cardiologist. J Cardiovasc Transl Res. 2013;6(2):187–96. https://doi.org/10.1007/s12265-012-9433-0.

    Article  PubMed  Google Scholar 

  38. Anderson RH, Becker AE, Tranum-Jensen J, Janse MJ. Anatomico-electrophysiological correlations in the conduction system--a review. Br Heart J. 1981;45(1):67–82. https://doi.org/10.1136/hrt.45.1.67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Pang BJ, Kumar S, Tacey MA, Mond HG. Capturing the his-Purkinje system is not possible from conventional right ventricular apical and nonapical pacing sites. Pacing and clinical electrophysiology : PACE. 2014;37(6):724–30. https://doi.org/10.1111/pace.12331.

    Article  PubMed  Google Scholar 

  40. Turak O, Ozcan F, Canpolat U, Başar FN, Işleyen A, Sökmen E, et al. Relation between QRS duration and atrial synchronicity in patients with systolic heart failure. Echocardiography (Mount Kisco, NY). 2014;31(8):972–9. https://doi.org/10.1111/echo.12504.

    Article  Google Scholar 

  41. Sinagra G, Proclemer A, Zecchin M. Resynchronization therapy in heart failure: the ‘nonresponder’. J Cardiovasc Med (Hagerstown). 2018;19(1):e112–e5. https://doi.org/10.2459/jcm.0000000000000567.

    Article  Google Scholar 

  42. Wu S, Su L, Vijayaraman P, Zheng R, Cai M, Xu L, et al. Left bundle branch pacing for cardiac resynchronization therapy: nonrandomized On-treatment comparison with his bundle pacing and biventricular pacing. The Canadian journal of cardiology. 2021;37(2):319–28. https://doi.org/10.1016/j.cjca.2020.04.037.

    Article  PubMed  Google Scholar 

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Funding

This study was funded by The Cultivation Project of Young and Middle-aged Academic Leaders of the First Hospital of Shanxi Medical University (Grant/Award Number: YD1609), Prospects for clinical applications of green electrophysiological techniques (Grant/Award Number:2018041) and Prospects for the application of green electrophysiological techniques in reducing radiation risks to doctors and patients (Grant/Award Number:201801D121222).

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Author notes

  1. Jia Gao and Bing-hang Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Physiology, Shanxi Medical University, Taiyuan, Shanxi, China

    Jia Gao

  2. Department of Cardiology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China

    Jia Gao, Nan Zhang, Meng Sun & Rui Wang

  3. The First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China

    Bing-hang Zhang

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  1. Jia Gao
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  2. Bing-hang Zhang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Jia Gao and Binghang Zhang. The first draft of the manuscript was written by Jia Gao and Binghang Zhang. Nan Zhang, Meng Sun, and Rui Wang revised it critically for important intellectual content. All authors read and approved the final manuscript.

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Correspondence to Rui Wang.

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Gao, J., Zhang, Bh., Zhang, N. et al. The electrocardiogram characteristics and pacing parameters of permanent left bundle branch pacing: a systematic review and meta-analysis. J Interv Card Electrophysiol 63, 215–224 (2022). https://doi.org/10.1007/s10840-021-01000-3

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