Clinical, hemodynamic and biochemical improvement related to left bundle branch area pacing

Pau Alonso Fernández, Unidad de Arritmias, Servicio de Cardiología, Hospital de Manises, Valencia, España
Diego Plaza, Unidad de Arritmias, Servicio de Cardiología, Hospital de Manises, Valencia, España
Paloma Oltra, Unidad de Arritmias, Servicio de Cardiología, Hospital de Manises, Instituto de Investigación Sanitaria la Fe. Valencia, España
Ingrid Cardells, Servicio de Cardiología, Hospital de Manises, Valencia, España
Carla Castillo, Servicio de Cardiología, Hospital de Manises, Valencia, España
Luis Mainar, Servicio de Cardiología, Hospital de Manises, Valencia, España

Background: Right ventricular pacing is associated with risk of heart failure and left ventricular dysfunction. Left bundle branch area pacing (LBBP) has emerged as an alternative method for delivering physiological pacing. The effect of LBBP on N-terminal probrain natriuretic peptide (NT-proBNP) has not been investigated. Method: Finally, 50 patients referred for pacemaker implantation were included. LBBP was performed as described previously by Huang et al. Transthoracic echocardiogram and NT-proBNP were performed before and four weeks after the procedure. Results: 50 patients were analyzed. There were not differences between ventricular thresholds during the procedure and 3 months later, LBBP significantly reduced QRS complex duration (148 ± 21 vs. 107 ± 11 ms; p = 0.029). LBBP significantly improved NYHA functional class and reduced NT-proBNP concentration (2888.2 ± 510 vs. 1181 ± 130 pg/ml; p = 0.04). In patients showing left ventricular ejection fraction (LVEF) < 50% and ventricular desynchrony LBBP showed a significant LVEF increase (40.2 ± 7 vs. 55.2 ± 7%; p < 0.001). Conclusions: LBBP was feasible and safe in most of patients. LBBP was associated with reduction in QRS width and with increase in LVEF in patients with ventricular desynchrony, while in patients with normal LVEF it remained unchanged during follow-up.

Keywords: Left bundle branch pacing. Heart Failure. Ventricular pacing.