Search

Background: Left bundle branch pacing (LBBP) is an alternative strategy for His bundle pacing (HBP), however little is known about tricuspid regurgitation (TR) deterioration after LBBP implantation.Objectives: This study aimed to characterize the incidence of post-LBBP TR deterioration and identify predicting factors, especially lead position parameters.Methods: Patients who received LBBP were continuously enrolled from January 2018 to August 2020. The progression of TR and the anatomic position of LBBP characterized by echocardiography.Results: A total of 89 patients were enrolled and assigned to two sub-groups based on the degree of TR before LBBP implantation. 58 (65.2%) patients with relatively normal TV function (Grade0/1 subgroup: with none/trivial or mild TR) and 31 (34.8%) with more severe TR (Grade2/3 subgroup: with moderate or severe TR). With 19.0±6.5 months of follow-up time, 29 (32.6%) patients had TR deterioration and 23 of them were in Grade 0/1 subgroup. In Grade 0/1 subgroup, patients with TR deterioration had a shorter distance between the lead-implanted site and tricuspid valve (Lead-TA-dist) than those without TR (19.0±7.6 vs 23.9±5.4, P=0.006). The receiver operating characteristic (ROC) curve (AUC=0.721, 95%CI 0.575 to 0.867, P=0.005) indicated the favorable efficacy of Lead-TA-dist for predicting TR deterioration after LBBP. The lead-TA-dist ≤ 16.1mm was independently associated with TR deterioration after LBBP (HR 0.20, 95% CI 0.06 - 0.76, P = 0.017).Conclusion: TR was a common complication of LBBP implantation. In patients with none/trivial or mild TR, lead-TA-dist ≤ 16.1mm was an independent predictor of TR deterioration after LBBP implantation. [ABSTRACT FROM AUTHOR]

Background Implantable cardioverter-defibrillator (ICD) implantation is a key therapeutic option in arrhythmogenic right ventricular cardiomyopathy (ARVC) to prevent sudden cardiac death due to ventricular tachycardia (VT) and fibrillation (VF). However, sub-optimized R-wave sensing due to myocardium loss interferes with VT/VF identification and appropriate therapy. We tried to implant a 3830 lead to the left ventricular septum (LVS) to facilitate ICD sensing in an ARVC patient. Case summary A 68-year-old woman diagnosed with ARVC was scheduled to undergo ICD implantation. Initially, no sites with suitable R-wave amplitudes were found in the right ventricle (RV) to deploy the defibrillation lead (<3.0 mV). It was likely due to severe RV involvement, but the LVS myocardium was more preserved based on cardiac magnetic resonance imaging. Therefore, we implanted a 3830 lead into the deep area of the septum to facilitate R-wave sensing. During the procedure from the right to left septum, the R-wave amplitude significantly increased (2.6 to 4.3–7.1 mV). Left ventricular septum pacing was finally achieved with favourable R-wave sensing (9.9 mV 24 h post-operation). The 3830 lead was plugged into the IS-1 port, while the defibrillation lead was plugged into the DF-1 port. After a 4-month follow-up, the R-wave amplitude of the 3830 lead was 11.1 mV. Discussion When the R-wave sensing is not acceptable for ICD implantation in ARVC patients, it is critical to assess myocardial conditions comprehensively. If the septal myocardium is preserved, implanting a 3830 lead to the deep or LVS is feasible to improve R-wave sensing. [ABSTRACT FROM AUTHOR]

Background: Several previous studies have explored the potential arterial blood pressure (BP) changes in patients undergoing right ventricular pacing (RVP), however, the relationship between left bundle branch area pacing (LBBAP) and BP variations remains unknown. This study aimed to examine the acute BP variations following LBBAP and RVP implantation in patients with bradycardia., Methods: We conducted a single-center retrospective study including all patients who underwent de-novo dual-chamber pacemaker implantation between January 2019 and June 2021. Patients were divided into two groups, LBBAP and RVP, and propensity score-matching (PSM) was used to balance confounding factors. Three time periods were defined according to the timing of the implant: baseline (within 24 hours before implantation), hyper-acute period (0-24 hours post-implantation), and acute period (24-48 hours post-implantation). BP was measured at least three times per period using an arm pressure cuff and then averaged for analysis, which allowed us to determine the acute impact of pacemaker implantation on BP., Results: From a cohort of 898 patients, 193 LBBAP receivers were matched to 193 RVP receivers. A significant decrease in systolic BP (SBP) after the implantation was observed in the study cohort, from baseline 137.3 ± 9.2 mmHg to the acute period of 127.7 ± 9.4 mmHg ( p < 0.001). The LBBAP group exhibited a greater SBP reduction than the RVP group ( Δ 11.6 ± 6.2 mmHg vs. Δ 7.6 ± 5.8 mmHg, p < 0.001). In further subgroup analysis, LBBAP receivers who had high baseline SBP ( p < 0.001) and those without using anti-hypertensive drugs ( p = 0.045) appeared to have a higher magnitude of SBP reduction., Conclusions: Permanent pacemaker implantation may contribute to an acute decrease in systolic BP, which was more pronounced in LBBAP receivers. Future experimental and clinical investigations are necessary to explore the underlying mechanisms and the long-term hemodynamic effects of LBBAP versus RVP., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 The Author(s). Published by IMR Press.)