左心室机械洞察左束支起搏和左室间隔起搏。

IF 7.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2025-08-01 DOI:10.1016/j.jacep.2025.03.037

Matteo Bertini MD, PhD , Francesco Vitali MD, PhD , Michele Malagù MD , Giorgia Azzolini MD , Stefano Clò MD , Luca Canovi MD , Jacopo Farina MD , Nicola Bianchi MD , Martina De Raffele MD , Chiara Bianchi MD , Marco De Pietri MD , Gabriele Guidi Colombi MD , Marco Micillo MD , Angelo Melpignano MD , Rita Pavasini MD , Cristina Balla MD, PhD , Gabriele Guardigli MD , Pugazhendhi Vijayaraman MD , Marco Zuin MD, MS, PhD

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引用次数: 0

摘要

背景：左心室（LV）机械效率与左束支区起搏（LBBAP）的关系尚不清楚。目的：本研究旨在评价左束支起搏（LBBP）、左室间隔起搏（LVSP）和心肌功（MW）两种不同模式LBBAP在左室射血分数正常或中度降低患者自发性心律和LBBAP之间的相关性。方法：从TREEBEARD（评价当代心脏刺激在临床实践中的作用：左、双室、右、传导系统起搏NCT06324682）前瞻性研究中检索患者，并根据是否接受LBBP或LVSP分为两组。使用诸如全球工作指数、全球建设性工作、全球浪费工作和全球工作效率等指标来评估工作效率。结果：共纳入155例患者(平均年龄73.3±14.3岁；74.8%为男性)，LBBP组102例，LVSP组53例。在LBBP组中，所有MW指标在自发节律和LBBP期间记录的值之间显示出很强的相关性。相反，LVSP组在整体工作指数上表现出中等相关性(r = 0.535；P = 0.004)，整体建设工作(r = 0.587；P = 0.009)，整体工作效率(r = 0.503；p = 0.01)。全球浪费的工作没有显示出统计学上显著的相关性(r = 0.641；p = 0.13)。结论：在左室射血分数保存或中度降低的患者中，LBBP表现出与自发左室激活相当的左室机械效率。相反，LVSP是一个有价值的选择，但左室力学受损，显示左心室GWE降低。当代心脏刺激在临床实践中的评价：左、双心室、右、传导系统起搏[TREEBEARD]；NCT06324682)。

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Left Ventricular Mechanical Insights Into Left Bundle Branch Pacing and Left Ventricular Septal Pacing

Background

The relationship between left ventricular (LV) mechanical efficiency and various modalities of left bundle branch area pacing (LBBAP) is not well understood.

Objectives

The goal of this study was to evaluate the correlation between 2 different modalities of LBBAP, including left bundle branch pacing (LBBP) and LV septal pacing (LVSP) and myocardial work (MW), during spontaneous rhythm and LBBAP in patients with normal or moderately reduced LV ejection fraction.

Methods

Patients were retrieved from the TREEBEARD (Evaluation of Contemporary Cardiac Stimulation in Clinical Practice: Left, Biventricular, Right, and Conduction System Pacing; NCT06324682) prospective study and categorized into 2 groups based on whether they received LBBP or LVSP. MW was assessed using metrics such as global work index, global constructive work, global wasted work, and global work efficiency.

Results

Overall, 155 patients were included in the study (mean age 73.3 ± 14.3 years; 74.8% male), with 102 in the LBBP group and 53 in the LVSP group. In the LBBP group, all MW indices displayed a strong correlation between values recorded during spontaneous rhythm and LBBP. Conversely, the LVSP group exhibited moderate correlations for global work index (r = 0.535; P = 0.004), global constructive work (r = 0.587; P = 0.009), and global work efficiency (r = 0.503; P = 0.01). Global wasted work did not show a statistically significant correlation (r = 0.641; P = 0.13).

Conclusions

In patients with preserved or moderately reduced LV ejection fraction, LBBP exhibited LV mechanical efficiency comparable to that of spontaneous LV activation. Conversely, LVSP is a valuable option, but LV mechanics is impaired, showing a reduced GWE of the left ventricle. (Evaluation of Contemporary Cardiac Stimulation in Clinical Practice: Left, Biventricular, Right, and Conduction System Pacing [TREEBEARD]; NCT06324682)

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.