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From Right to Left: Left Bundle Branch Area Pacing vs Conventional Right Ventricular Pacing
Session:
Comunicações Orais - Sessão 16 - Pacing cardíaco
Speaker:
Diogo De Almeida Fernandes
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.6 Device Therapy - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Diogo De Almeida Fernandes; João André Ferreira; Patrícia Alves; Carolina Saleiro; Natália António; Luís Elvas; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>INTRODUCTION</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Right ventricular pacing (RVp) is the most used pacing technique worldwide. Nevertheless, high pacing percentages may lead to pacing induced cardiomyopathy (PICM). Due to its more physiologic profile, left bundle branch area pacing (LBBAP) has arisen as an alternative that may improve clinical outcomes. Our aim was to compare procedural and clinical outcomes of RVp and LBBAP.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Single-center cohort study including consecutive patients who underwent LBBAP or RVp from Jan to Dec 2023. LBBAP was performed by implanting the ventricular pacing lead using the tricuspid summit technique aided by pace mapping aiming for an LV activation time (LVAT) < 80 ms and/or V6–V1 inter-peak interval > 40ms. Regarding RVp, both apical and septal implanted leads were included. Primary outcome was a composite of heart failure (HF) emergency department (ER) admission, HF hospitalization and all-cause mortality. Patients were considered at risk for PICM if pacing percentage was > 20%.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">139 patients underwent LBBAP and 586 RVp (58.5% septal and 41.5% apical). There were no differences on baseline regarding comorbidities. Complete atrioventricular (AV) block was the most frequent indication in all groups (42.4% LBBAP vs 45.7% septal vs 35.8% apical). LBBAP patients had lower LVEF (51% vs 57% in both methods of RVp, p< 0.001) and wider basal QRS (140 ± 33 ms vs 129 ± 27 septal vs 123 ± 28 ms apical, p < 0.001). Average LVAT was 77 ± 8 ms. Paced QRS was shorter in LBBAP (115 ± 15 ms vs septal 150 ± 17 ms vs apical 163 ± 19 ms, p <0.001). Procedural duration was higher in LBBAP (82 vs 60 min, p <0.001) as well as fluoroscopy time (13.8 vs 6.4 septal vs 3.8 apical min, p < 0.001). Acute R-wave amplitude was higher in LBBAP (p <0.001) and pacing thresholds were similar (p 0.899). After a median follow-up time of 7.8 months, LVEF increased by 7 ± 8% in LBBAP (vs -4 ± 7% septal and -5 ± 10% apical, p < 0.001). Primary outcome occurred in 5.1% of patients with LBBAP vs 16.0% septal and 24.3% apical (p <0.001). After adjusting for differences at baseline, patients with pacing percentage > 20% had a higher risk of fulfilling the primary endpoint, particularly patients with apical pacing (HR 7.3, 95% CI 2.04-26.01, vs. septal pacing HR 3.96, 95% CI 1.14-13.83, p 0.031). </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSION</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">LBBAP is a feasible pacing technique which leads to shorter paced QRS and improved LV function. Our data suggests improved short and medium term outcomes in this subset of patients.</span></span></p>
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