Feasibility and safety of left bundle branch area pacing-cardiac resynchronization therapy in elderly patients.
Cardiac resynchronization therapy
Conduction system pacing
Elderly patients
Heart failure
Left bundle branch area pacing
Journal
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
ISSN: 1572-8595
Titre abrégé: J Interv Card Electrophysiol
Pays: Netherlands
ID NLM: 9708966
Informations de publication
Date de publication:
Mar 2023
Mar 2023
Historique:
received:
27
12
2021
accepted:
27
02
2022
pubmed:
11
3
2022
medline:
4
3
2023
entrez:
10
3
2022
Statut:
ppublish
Résumé
Left bundle branch area pacing (LBBAP) is an emerging technique to achieve cardiac resynchronization therapy (CRT), but its feasibility and safety in elderly patients with heart failure with reduced ejection fraction and left bundle branch block is hardly investigated. We enrolled consecutive patients with an indication for CRT comparing pacing parameters and complication rates of LBBAP-CRT in elderly patients (≥ 75 years) versus younger patients (< 75 years) over a 6-month follow-up. LBBAP was successful in 55/60 enrolled patients (92%), among which 25(45%) were elderly. In both groups, LBBAP significantly reduced the QRS duration (elderly group: 168 ± 15 ms to 136 ± 12 ms, p < 0.0001; younger group: 166 ± 14 ms to 134 ± 11 ms, p < 0.0001) and improved LVEF (elderly group: 28 ± 5% to 40 ± 7%, p < 0.0001; younger group: 29 ± 5% to 41 ± 8%, p < 0.0001). The pacing threshold was 0.9 ± 0.8 V in the elderly group vs. 0.7 ± 0.5 V in the younger group (p = 0.350). The R wave was 9.5 ± 3.9 mV in elderly patients vs. 10.7 ± 2.7 mV in younger patients (p = 0.341). The fluoroscopic (elderly: 13 ± 7 min vs. younger: 11 ± 7 min, p = 0.153) and procedural time (elderly: 80 ± 20 min vs. younger: 78 ± 16 min, p = 0.749) were comparable between groups. Lead dislodgement occurred in 2(4%) patients, 1 in each group (p = 1.000). Intraprocedural septal perforation occurred in three patients (5%), 2(8%) in the elderly group (p = 0.585). One patient (2%) in the elderly group had a pocket infection. LBBAP is a feasible and safe technique for delivering physiological pacing in elderly patients who are candidates for CRT with suitable pacing parameters and low complication rates.
Sections du résumé
BACKGROUND
BACKGROUND
Left bundle branch area pacing (LBBAP) is an emerging technique to achieve cardiac resynchronization therapy (CRT), but its feasibility and safety in elderly patients with heart failure with reduced ejection fraction and left bundle branch block is hardly investigated.
METHODS
METHODS
We enrolled consecutive patients with an indication for CRT comparing pacing parameters and complication rates of LBBAP-CRT in elderly patients (≥ 75 years) versus younger patients (< 75 years) over a 6-month follow-up.
RESULTS
RESULTS
LBBAP was successful in 55/60 enrolled patients (92%), among which 25(45%) were elderly. In both groups, LBBAP significantly reduced the QRS duration (elderly group: 168 ± 15 ms to 136 ± 12 ms, p < 0.0001; younger group: 166 ± 14 ms to 134 ± 11 ms, p < 0.0001) and improved LVEF (elderly group: 28 ± 5% to 40 ± 7%, p < 0.0001; younger group: 29 ± 5% to 41 ± 8%, p < 0.0001). The pacing threshold was 0.9 ± 0.8 V in the elderly group vs. 0.7 ± 0.5 V in the younger group (p = 0.350). The R wave was 9.5 ± 3.9 mV in elderly patients vs. 10.7 ± 2.7 mV in younger patients (p = 0.341). The fluoroscopic (elderly: 13 ± 7 min vs. younger: 11 ± 7 min, p = 0.153) and procedural time (elderly: 80 ± 20 min vs. younger: 78 ± 16 min, p = 0.749) were comparable between groups. Lead dislodgement occurred in 2(4%) patients, 1 in each group (p = 1.000). Intraprocedural septal perforation occurred in three patients (5%), 2(8%) in the elderly group (p = 0.585). One patient (2%) in the elderly group had a pocket infection.
CONCLUSIONS
CONCLUSIONS
LBBAP is a feasible and safe technique for delivering physiological pacing in elderly patients who are candidates for CRT with suitable pacing parameters and low complication rates.
Identifiants
pubmed: 35266067
doi: 10.1007/s10840-022-01174-4
pii: 10.1007/s10840-022-01174-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
311-321Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–726.
doi: 10.1093/eurheartj/ehab368
pubmed: 34447992
Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021;42(35):3427–520.
doi: 10.1093/eurheartj/ehab364
pubmed: 34455430
Strisciuglio T, Stabile G, Pecora D, Arena G, Caico SI, Marini M, et al. Does the Age Affect the Outcomes of Cardiac Resynchronization Therapy in Elderly Patients? J Clin Med. 2021;10(7).
Naqvi SY, Jawaid A, Goldenberg I, Kutyifa V. Non-response to Cardiac Resynchronization Therapy. Curr Heart Fail Rep. 2018;15(5):315–21.
doi: 10.1007/s11897-018-0407-7
pubmed: 30097910
Guo J, Li L, Xiao G, Ye T, Huang X, Meng F, et al. Remarkable response to cardiac resynchronization therapy via left bundle branch pacing in patients with true left bundle branch block. Clin Cardiol. 2020;43(12):1460–8.
doi: 10.1002/clc.23462
pubmed: 32960993
pmcid: 7724211
Huang W, Wu S, Vijayaraman P, Su L, Chen X, Cai B, et al. Cardiac Resynchronization Therapy in Patients With Nonischemic Cardiomyopathy Using Left Bundle Branch Pacing. JACC Clin Electrophysiol. 2020;6(7):849–58.
doi: 10.1016/j.jacep.2020.04.011
pubmed: 32703568
Cano Ó, Vijayaraman P. Left Bundle Branch Area Pacing: Implant Technique, Definitions, Outcomes, and Complications. Curr Cardiol Rep. 2021;23(11):155.
doi: 10.1007/s11886-021-01585-1
pubmed: 34599430
Sharma PS, Patel NR, Ravi V, Zalavadia DV, Dommaraju S, Garg V, et al. Clinical outcomes of left bundle branch area pacing compared to right ventricular pacing: Results from the Geisinger-Rush Conduction System Pacing Registry. Heart Rhythm. 2022;19(1):3–11.
doi: 10.1016/j.hrthm.2021.08.033
pubmed: 34481985
Vijayaraman P, Ponnusamy S, Cano Ó, Sharma PS, Naperkowski A, Subsposh FA, et al. Left Bundle Branch Area Pacing for Cardiac Resynchronization Therapy: Results From the International LBBAP Collaborative Study Group. JACC Clin Electrophysiol. 2021;7(2):135–47.
doi: 10.1016/j.jacep.2020.08.015
pubmed: 33602393
Ijaz N, Buta B, Xue Q-L, Mohess DT, Bushan A, Tran H, et al. Interventions for Frailty Among Older Adults With Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2022;79(5):482–503.
doi: 10.1016/j.jacc.2021.11.029
pubmed: 35115105
pmcid: 8852369
Volgman AS, Nair G, Lyubarova R, Merchant FM, Mason P, Curtis AB, et al. Management of Atrial Fibrillation in Patients 75 Years and Older: JACC State-of-the-Art Review. J Am Coll Cardiol. 2022;79(2):166–79.
doi: 10.1016/j.jacc.2021.10.037
pubmed: 35027110
Díez-Villanueva P, Jiménez-Méndez C, Alfonso F. Heart failure in the elderly. J Geriatr Cardiol. 2021;18(3):219–32.
pubmed: 33907552
pmcid: 8047189
Huang W, Chen X, Su L, Wu S, Xia X, Vijayaraman P. A beginner’s guide to permanent left bundle branch pacing. Heart Rhythm. 2019;16(12):1791–6.
doi: 10.1016/j.hrthm.2019.06.016
pubmed: 31233818
Jastrzębski M, Kiełbasa G, Curila K, Moskal P, Bednarek A, Rajzer M, et al. Physiology-based electrocardiographic criteria for left bundle branch capture. Heart Rhythm. 2021;18(6):935–43.
doi: 10.1016/j.hrthm.2021.02.021
pubmed: 33677102
Jastrzębski M, Moskal P, Bednarek A, Kiełbasa G, Kusiak A, Sondej T, et al. Programmed deep septal stimulation: A novel maneuver for the diagnosis of left bundle branch capture during permanent pacing. J Cardiovasc Electrophysiol. 2020;31(2):485–93.
doi: 10.1111/jce.14352
pubmed: 31930753
Tokodi M, Schwertner WR, Kovács A, Tősér Z, Staub L, Sárkány A, et al. Machine learning-based mortality prediction of patients undergoing cardiac resynchronization therapy: the SEMMELWEIS-CRT score. Eur Heart J. 2020;41(18):1747–56.
doi: 10.1093/eurheartj/ehz902
pubmed: 31923316
pmcid: 7205468
Bertaglia E, Arena G, Pecora D, Reggiani A, D’Onofrio A, Palmisano P, et al. The VALID-CRT risk score reliably predicts response and outcome of cardiac resynchronization therapy in a real-world population. Clin Cardiol. 2019;42(10):919–24.
doi: 10.1002/clc.23229
pubmed: 31301152
pmcid: 6788573
Senes J, Mascia G, Bottoni N, Oddone D, Donateo P, Grimaldi T, et al. Is His-optimized superior to conventional cardiac resynchronization therapy in improving heart failure? Results from a propensity-matched study. Pacing Clin Electrophysiol. 2021;44(9):1532–9.
doi: 10.1111/pace.14336
pubmed: 34374444
Sharma PS, Vijayaraman P. Conduction System Pacing for Cardiac Resynchronisation. Arrhythm Electrophysiol Rev. 2021;10(1):51–8.
doi: 10.15420/aer.2020.45
pubmed: 33936744
pmcid: 8076975
Teigeler T, Kolominsky J, Vo C, Shepard RK, Kalahasty G, Kron J, et al. Intermediate-term performance and safety of His-bundle pacing leads: A single-center experience. Heart Rhythm. 2021;18(5):743–9.
doi: 10.1016/j.hrthm.2020.12.031
pubmed: 33418127
Upadhyay GA, Vijayaraman P, Nayak HM, Verma N, Dandamudi G, Sharma PS, et al. On-treatment comparison between corrective His bundle pacing and biventricular pacing for cardiac resynchronization: A secondary analysis of the His-SYNC Pilot Trial. Heart Rhythm. 2019;16(12):1797–807.
doi: 10.1016/j.hrthm.2019.05.009
pubmed: 31096064
Huang W, Zhou X, Ellenbogen KA. Pursue physiological pacing therapy: A better understanding of left bundle branch pacing and left ventricular septal myocardial pacing. Heart Rhythm. 2021;18(8):1290–1.
doi: 10.1016/j.hrthm.2021.05.013
pubmed: 33992731
Huang W, Su L, Wu S, Xu L, Xiao F, Zhou X, et al. A Novel Pacing Strategy With Low and Stable Output: Pacing the Left Bundle Branch Immediately Beyond the Conduction Block. Can J Cardiol. 2017;33(12):1736.e1-.e3.
Wu S, Chen X, Wang S, Xu L, Xiao F, Huang Z, et al. Evaluation of the Criteria to Distinguish Left Bundle Branch Pacing From Left Ventricular Septal Pacing. JACC Clin Electrophysiol. 2021;7(9):1166–77.
doi: 10.1016/j.jacep.2021.02.018
pubmed: 33933414
Zhang W, Huang J, Qi Y, Wang F, Guo L, Shi X, et al. Cardiac resynchronization therapy by left bundle branch area pacing in patients with heart failure and left bundle branch block. Heart Rhythm. 2019;16(12):1783–90.
doi: 10.1016/j.hrthm.2019.09.006
pubmed: 31513945
Wang Y, Gu K, Qian Z, Hou X, Chen X, Qiu Y, et al. The efficacy of left bundle branch area pacing compared with biventricular pacing in patients with heart failure: A matched case–control study. J Cardiovasc Electrophysiol. 2020;31(8):2068–77.
doi: 10.1111/jce.14628
pubmed: 32562442
Ponnusamy SS, Bopanna D, Syed T, Muthu G, Kumar S. Feasibility, safety and outcomes of left bundle branch pacing in octogenarians. Indian Heart J. 2021;73(1):117–20.
doi: 10.1016/j.ihj.2020.12.017
pubmed: 33714396
pmcid: 7961252
Vinther M, Risum N, Svendsen JH, Møgelvang R, Philbert BT. A Randomized Trial of His Pacing Versus Biventricular Pacing in Symptomatic HF Patients With Left Bundle Branch Block (His-Alternative). JACC Clin Electrophysiol. 2021.
Ravi V, Hanifin JL, Larsen T, Huang HD, Trohman RG, Sharma PS. Pros and Cons of Left Bundle Branch Pacing: A Single-Center Experience. Circ Arrhythm Electrophysiol. 2020;13(12):e008874.
Chen X, Wei L, Bai J, Wang W, Qin S, Wang J, et al. Procedure-Related Complications of Left Bundle Branch Pacing: A Single-Center Experience. Front Cardiovasc Med. 2021;8(195).
Heckman LIB, Luermans J, Curila K, Van Stipdonk AMW, Westra S, Smisek R, et al. Comparing Ventricular Synchrony in Left Bundle Branch and Left Ventricular Septal Pacing in Pacemaker Patients. J Clin Med. 2021;10(4).
Ponnusamy SS, Basil W, Vijayaraman P. Electrophysiological characteristics of septal perforation during left bundle branch pacing. Heart Rhythm. 2022.
Li X, Qiu C, Xie R, Ma W, Wang Z, Li H, et al. Left bundle branch area pacing delivery of cardiac resynchronization therapy and comparison with biventricular pacing. ESC Heart Failure. 2020;7(4):1711–22.
doi: 10.1002/ehf2.12731
pubmed: 32400967
pmcid: 7373885
Strisciuglio T, Ammirati G, Pergola V, Imparato L, Carella C, Koci E, et al. Contrast-induced nephropathy after cardiac resynchronization therapy implant impairs the recovery of ejection fraction in responders. ESC Heart Fail. 2019;6(6):1266–73.
doi: 10.1002/ehf2.12523
pubmed: 31833232
pmcid: 6989291
Jiang Z, Chang Q, Wu Y, Ji L, Zhou X, Shan Q. Typical BBB morphology and implantation depth of 3830 electrode predict QRS correction by left bundle branch area pacing. Pacing Clin Electrophysiol. 2020;43(1):110–7.
doi: 10.1111/pace.13849
pubmed: 31773756