Differences in Tricuspid Valve Insufficiency, Mechanical Synchrony, and Cardiac Remodeling Between Left Bundle Branch Area Pacing and Right Ventricular Pacing.

IF 7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm Pub Date : 2026-10-09 DOI:10.1016/j.hrthm.2026.10.003

Qing Jin, Zhan Li, Xingbiao Ren, Junjie Li, Min He, Yaoqian Zhang, Haiyan Wang

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引用次数: 0

Abstract

Background: Cardiac implantable electronic device-induced tricuspid regurgitation (CIED-induced TR) involves primary (lead-induced) and functional etiologies. The impact of left bundle branch area pacing (LBBAP) versus right ventricular pacing (RVP) on these mechanisms remains unclear.

Objective: To compare the incidence and mechanisms of TR among pacing modalities, and evaluate the prognostic significance of these mechanisms.

Methods: We analyzed 225 patients with first-time RV apical pacing (RVAP, n=97) or RV septal pacing (RVSP, n=78) using stylet-driven leads, and LBBAP (n=50) using lumenless leads. Echocardiography and electrocardiography were performed at baseline and 2 years post-implantation. Three-dimensional echocardiography assessed lead interference. Kaplan-Meier analysis compared event-free survival between lead-induced (LITR) and functional TR (FTR) groups. Cox regression identified predictors for adverse outcomes.

Results: Despite a higher baseline heart failure burden than RVP (P< .001), LBBAP showed the lowest TR progression rate (20.0% vs RVAP 43.3% vs RVSP 35.9%, P=.020) over 25.8 months. Mechanistically, LBBAP shortened QRS duration (vs RVP widening, P< .001) and demonstrated less lead interference than RVAP (28.0% vs 50.5%, P= .009). Furthermore, LBBAP showed greater left-heart reverse remodeling and improvement in mitral regurgitation, while preserving right-heart structure and function better than RVP. Over 37.4 months, LITR showed worse outcomes than FTR (P= .03). LITR, pulmonary hypertension, reduced left ventricular ejection fraction, and elevated creatinine were independent predictors for adverse outcomes.

Conclusion: LBBAP was associated with less CIED-induced TR than RVP, likely through reduced mechanical interference, superior electrical synchrony, and favorable cardiac remodeling. Furthermore, LITR was associated with a worse prognosis than FTR.

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左束支区起搏与右室起搏在三尖瓣功能不全、机械同步和心脏重构方面的差异。

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.