Left Bundle Branch Area Pacing Improves Left Atrial Outcomes in Pacemaker-Dependent Patients: A Prospective Cohort Study Using Speckle Tracking and Three-Dimensional Echocardiography.

IF 2.8 3区医学 Q1 Pharmacology, Toxicology and Pharmaceutics

Therapeutics and Clinical Risk Management Pub Date : 2025-09-13 eCollection Date: 2025-01-01 DOI:10.2147/TCRM.S481237

Yingchen Mei, Rui Han, Liting Cheng, Zefeng Wang, Yihua He, Wei Liu, Yongquan Wu

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Abstract

Purpose: Evidence that left bundle branch area pacing (LBBAP) is more effective than conventional right ventricular (RV) pacing in enhancing left atrial (LA) outcomes is lacking. The aim of this study was to investigate LA outcomes using 2-dimensional speckle tracking echocardiography (2D-STE) and real-time 3-dimensional echocardiography (RT-3DE) at 6-months of follow-up in patients that received LBBAP, RV septal pacing (RVSP), or RV apical pacing (RVAP).

Methods: A total of 90 patients with normal left ventricular ejection fraction (LVEF) underwent dual-chamber pacemaker implantation for bradycardia at Beijing Anzhen Hospital between January 2021 and July 2021. Patients were divided into three groups based on the pacing site: LBBAP, RVSP, or RVAP.

Results: There were no significant differences in baseline characteristics and echocardiographic findings among patients that received LBBAP, RVSP, or RVAP. At 6-months of follow-up, left atrial volume index (LAVI), LA reservoir strain (LASr), LA contractile strain (LASct), global longitudinal strain (GLS), global circumferential strain (GCS), and synchronization parameters (Tmsv-16SD, Tmsv-12SD, Tmsv-6SD, longitudinal Tε-dif, circumferential Tε-dif) were significantly improved in patients that received LBBAP, while they had significantly worsened with RVSP and RVAP. Compared to baseline, at 6-months of follow-up, patients that received LBBAP had significantly improved LASr (28.17±10.12% vs 35.4±17.17%, P=0.024), LASct (-12.03±2.15% vs -17.53±7.37%, P=0.045), E/e' ratio(12.61±3.8 vs 10.85±3.75,P=0.014) and LVEF (65.74±7.90% vs 68.81±5.92%, P=0.023). The 6-minute walking distance significantly increased at 6-months of follow-up compared to baseline in all patients, but the increase was most prominent for LBBAP (403.00±98.46 m vs. 469.34±59.32m, P=0.015). LBBAP was associated with a lower risk of new-onset atrial fibrillation.

Conclusion: In pacemaker-dependent patients, LBBAP achieved better LA strain, LV strain, and LV synchronization than RVSP or RVAP at 6-months of follow-up.

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左束支区起搏改善起搏器依赖患者的左心房预后：一项使用斑点跟踪和三维超声心动图的前瞻性队列研究。

目的：缺乏证据表明左束分支区域起搏（LBBAP）比传统的右心室起搏（RV）更有效地改善左房（LA）的预后。本研究的目的是利用二维斑点跟踪超声心动图（2D-STE）和实时三维超声心动图（RT-3DE）对接受LBBAP、RV室间隔起搏（RVSP）或RV根尖起搏（RVAP）的患者进行6个月的随访，研究LA的结果。方法：于2021年1月至2021年7月在北京安贞医院接受双室起搏器植入治疗心动过缓的90例左室射血分数（LVEF）正常患者。患者根据起搏部位分为三组：LBBAP、RVSP或RVAP。结果：在接受LBBAP、RVSP或RVAP治疗的患者中，基线特征和超声心动图结果无显著差异。随访6个月，LBBAP组左房容积指数（LAVI）、左房储层应变（LASr）、左房收缩应变（LASct）、左房总纵向应变（GLS）、左房总周向应变（GCS）、左房同步参数（Tmsv-16SD、Tmsv-12SD、Tmsv-6SD、纵向Tε-dif、周向Tε-dif）显著改善，RVSP、RVAP组左房容积指数（LAVI）显著恶化。与基线相比，随访6个月时，接受LBBAP治疗的患者LASr（28.17±10.12% vs 35.4±17.17%，P=0.024）、LASct（-12.03±2.15% vs -17.53±7.37%，P=0.045）、E/ E′比（12.61±3.8 vs 10.85±3.75，P=0.014）和LVEF（65.74±7.90% vs 68.81±5.92%，P=0.023）均有显著改善。随访6个月时，所有患者的6分钟步行距离均较基线显著增加，但LBBAP的6分钟步行距离增加最为明显（403.00±98.46 m vs 469.34±59.32m， P=0.015）。LBBAP与较低的新发房颤风险相关。结论：在起搏器依赖患者中，LBBAP在6个月的随访中比RVSP或RVAP获得更好的左室应变、左室应变和左室同步。

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来源期刊

Therapeutics and Clinical Risk Management HEALTH CARE SCIENCES & SERVICES-

CiteScore

5.30

自引率

3.60%

发文量

139

审稿时长

16 weeks

期刊介绍： Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas. The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature. As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication. The journal does not accept study protocols, animal-based or cell line-based studies.