Cardiac Resynchronization Therapy in Patients With Nonischemic Cardiomyopathy Using Left Bundle Branch Pacing

Weijian Huang; Shengjie Wu; Pugazhendhi Vijayaraman; Lan Su; Xueying Chen; Bingni Cai; Jiangang Zou; Rongfang Lan; Guosheng Fu; Guangyun Mao; Kenneth A. Ellenbogen; Zachary I. Whinnett; Roderick Tung

doi:10.1016/j.jacep.2020.04.011

Cardiac Resynchronization Therapy in Patients With Nonischemic Cardiomyopathy Using Left Bundle Branch Pacing

Weijian Huang, Shengjie Wu, Pugazhendhi Vijayaraman, Lan Su, Xueying Chen, Bingni Cai, Jiangang Zou, Rongfang Lan, Guosheng Fu, Guangyun Mao, Kenneth A. Ellenbogen, Zachary I. Whinnett, Roderick Tung

Research output: Contribution to journal › Article › peer-review

227 Scopus citations

Abstract

Objectives: The aim of this study was to assess the feasibility and efficacy of left bundle branch pacing (LBBP) using a novel intraseptal technique to deliver cardiac resynchronization therapy (CRT) in patients with left bundle branch block (LBBB) and nonischemic cardiomyopathy. Background: His bundle pacing to correct LBBB is a viable alternative approach to achieve CRT but is limited by suboptimal lead delivery and high thresholds. Methods: This was a prospective, multicenter study performed between June 2017 and August 2018 at 6 centers. Patients with nonischemic cardiomyopathy, complete LBBB, and left ventricular ejection fractions (LVEFs) ≤50% who had indications for CRT and/or ventricular pacing in whom LBBP was attempted were included. Success rates, QRS duration, LVEF, left ventricular end-systolic volume, and improvement in functional class were assessed. Results: LBBP was successful in 61 of 63 patients (97%, mean age 68 ± 11 years, 52.4% men). During LBBP, QRS duration narrowed from 169 ± 16 to 118 ± 12 ms (p < 0.001). Pacing threshold and R-wave amplitude remained stable at 1-year follow-up compared with implantation values (0.5 ± 0.15 V/0.5 ms vs. 0.58 ± 0.14 V/0.5 ms and 11.1 ± 4.9 mV vs. 13.3 ± 5.3 mV, respectively). LVEF increased significantly (33 ± 8% vs. 55 ± 10%; p < 0.001), with a reduction in left ventricular end-systolic volume (123 ± 61 ml vs. 67 ± 39 ml; p < 0.001). LVEF had normalized (≥50%) in 75% of patients at 1 year. New York Heart Association functional class improved significantly from 2.8 ± 0.6 at baseline to 1.4 ± 0.6 at 1 year. No deaths or heart failure hospitalizations were observed during follow-up. Conclusions: LBBP is a feasible and effective method for achieving electric resynchronization of LBBB, with resultant improvements in left ventricular structure and function. Low and stable pacing thresholds may be advantageous over His bundle pacing for CRT in patients with LBBB and nonischemic cardiomyopathy.

Original language	English (US)
Pages (from-to)	849-858
Number of pages	10
Journal	JACC: Clinical Electrophysiology
Volume	6
Issue number	7
DOIs	https://doi.org/10.1016/j.jacep.2020.04.011
State	Published - Jul 2020
Externally published	Yes

Keywords

His bundle pacing
cardiac resynchronization therapy
heart failure
left bundle branch block
left bundle branch pacing
left conduction system

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

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10.1016/j.jacep.2020.04.011

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@article{c1488a26e299419ebe98b5dc635964a7,

title = "Cardiac Resynchronization Therapy in Patients With Nonischemic Cardiomyopathy Using Left Bundle Branch Pacing",

abstract = "Objectives: The aim of this study was to assess the feasibility and efficacy of left bundle branch pacing (LBBP) using a novel intraseptal technique to deliver cardiac resynchronization therapy (CRT) in patients with left bundle branch block (LBBB) and nonischemic cardiomyopathy. Background: His bundle pacing to correct LBBB is a viable alternative approach to achieve CRT but is limited by suboptimal lead delivery and high thresholds. Methods: This was a prospective, multicenter study performed between June 2017 and August 2018 at 6 centers. Patients with nonischemic cardiomyopathy, complete LBBB, and left ventricular ejection fractions (LVEFs) ≤50% who had indications for CRT and/or ventricular pacing in whom LBBP was attempted were included. Success rates, QRS duration, LVEF, left ventricular end-systolic volume, and improvement in functional class were assessed. Results: LBBP was successful in 61 of 63 patients (97%, mean age 68 ± 11 years, 52.4% men). During LBBP, QRS duration narrowed from 169 ± 16 to 118 ± 12 ms (p < 0.001). Pacing threshold and R-wave amplitude remained stable at 1-year follow-up compared with implantation values (0.5 ± 0.15 V/0.5 ms vs. 0.58 ± 0.14 V/0.5 ms and 11.1 ± 4.9 mV vs. 13.3 ± 5.3 mV, respectively). LVEF increased significantly (33 ± 8% vs. 55 ± 10%; p < 0.001), with a reduction in left ventricular end-systolic volume (123 ± 61 ml vs. 67 ± 39 ml; p < 0.001). LVEF had normalized (≥50%) in 75% of patients at 1 year. New York Heart Association functional class improved significantly from 2.8 ± 0.6 at baseline to 1.4 ± 0.6 at 1 year. No deaths or heart failure hospitalizations were observed during follow-up. Conclusions: LBBP is a feasible and effective method for achieving electric resynchronization of LBBB, with resultant improvements in left ventricular structure and function. Low and stable pacing thresholds may be advantageous over His bundle pacing for CRT in patients with LBBB and nonischemic cardiomyopathy.",

keywords = "His bundle pacing, cardiac resynchronization therapy, heart failure, left bundle branch block, left bundle branch pacing, left conduction system",

author = "Weijian Huang and Shengjie Wu and Pugazhendhi Vijayaraman and Lan Su and Xueying Chen and Bingni Cai and Jiangang Zou and Rongfang Lan and Guosheng Fu and Guangyun Mao and Ellenbogen, {Kenneth A.} and Whinnett, {Zachary I.} and Roderick Tung",

note = "Publisher Copyright: {\textcopyright} 2020 American College of Cardiology Foundation",

year = "2020",

month = jul,

doi = "10.1016/j.jacep.2020.04.011",

language = "English (US)",

volume = "6",

pages = "849--858",

journal = "JACC: Clinical Electrophysiology",

issn = "2405-500X",

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T1 - Cardiac Resynchronization Therapy in Patients With Nonischemic Cardiomyopathy Using Left Bundle Branch Pacing

AU - Huang, Weijian

AU - Wu, Shengjie

AU - Vijayaraman, Pugazhendhi

AU - Su, Lan

AU - Chen, Xueying

AU - Cai, Bingni

AU - Zou, Jiangang

AU - Lan, Rongfang

AU - Fu, Guosheng

AU - Mao, Guangyun

AU - Ellenbogen, Kenneth A.

AU - Whinnett, Zachary I.

AU - Tung, Roderick

PY - 2020/7

Y1 - 2020/7

N2 - Objectives: The aim of this study was to assess the feasibility and efficacy of left bundle branch pacing (LBBP) using a novel intraseptal technique to deliver cardiac resynchronization therapy (CRT) in patients with left bundle branch block (LBBB) and nonischemic cardiomyopathy. Background: His bundle pacing to correct LBBB is a viable alternative approach to achieve CRT but is limited by suboptimal lead delivery and high thresholds. Methods: This was a prospective, multicenter study performed between June 2017 and August 2018 at 6 centers. Patients with nonischemic cardiomyopathy, complete LBBB, and left ventricular ejection fractions (LVEFs) ≤50% who had indications for CRT and/or ventricular pacing in whom LBBP was attempted were included. Success rates, QRS duration, LVEF, left ventricular end-systolic volume, and improvement in functional class were assessed. Results: LBBP was successful in 61 of 63 patients (97%, mean age 68 ± 11 years, 52.4% men). During LBBP, QRS duration narrowed from 169 ± 16 to 118 ± 12 ms (p < 0.001). Pacing threshold and R-wave amplitude remained stable at 1-year follow-up compared with implantation values (0.5 ± 0.15 V/0.5 ms vs. 0.58 ± 0.14 V/0.5 ms and 11.1 ± 4.9 mV vs. 13.3 ± 5.3 mV, respectively). LVEF increased significantly (33 ± 8% vs. 55 ± 10%; p < 0.001), with a reduction in left ventricular end-systolic volume (123 ± 61 ml vs. 67 ± 39 ml; p < 0.001). LVEF had normalized (≥50%) in 75% of patients at 1 year. New York Heart Association functional class improved significantly from 2.8 ± 0.6 at baseline to 1.4 ± 0.6 at 1 year. No deaths or heart failure hospitalizations were observed during follow-up. Conclusions: LBBP is a feasible and effective method for achieving electric resynchronization of LBBB, with resultant improvements in left ventricular structure and function. Low and stable pacing thresholds may be advantageous over His bundle pacing for CRT in patients with LBBB and nonischemic cardiomyopathy.

AB - Objectives: The aim of this study was to assess the feasibility and efficacy of left bundle branch pacing (LBBP) using a novel intraseptal technique to deliver cardiac resynchronization therapy (CRT) in patients with left bundle branch block (LBBB) and nonischemic cardiomyopathy. Background: His bundle pacing to correct LBBB is a viable alternative approach to achieve CRT but is limited by suboptimal lead delivery and high thresholds. Methods: This was a prospective, multicenter study performed between June 2017 and August 2018 at 6 centers. Patients with nonischemic cardiomyopathy, complete LBBB, and left ventricular ejection fractions (LVEFs) ≤50% who had indications for CRT and/or ventricular pacing in whom LBBP was attempted were included. Success rates, QRS duration, LVEF, left ventricular end-systolic volume, and improvement in functional class were assessed. Results: LBBP was successful in 61 of 63 patients (97%, mean age 68 ± 11 years, 52.4% men). During LBBP, QRS duration narrowed from 169 ± 16 to 118 ± 12 ms (p < 0.001). Pacing threshold and R-wave amplitude remained stable at 1-year follow-up compared with implantation values (0.5 ± 0.15 V/0.5 ms vs. 0.58 ± 0.14 V/0.5 ms and 11.1 ± 4.9 mV vs. 13.3 ± 5.3 mV, respectively). LVEF increased significantly (33 ± 8% vs. 55 ± 10%; p < 0.001), with a reduction in left ventricular end-systolic volume (123 ± 61 ml vs. 67 ± 39 ml; p < 0.001). LVEF had normalized (≥50%) in 75% of patients at 1 year. New York Heart Association functional class improved significantly from 2.8 ± 0.6 at baseline to 1.4 ± 0.6 at 1 year. No deaths or heart failure hospitalizations were observed during follow-up. Conclusions: LBBP is a feasible and effective method for achieving electric resynchronization of LBBB, with resultant improvements in left ventricular structure and function. Low and stable pacing thresholds may be advantageous over His bundle pacing for CRT in patients with LBBB and nonischemic cardiomyopathy.

KW - His bundle pacing

KW - cardiac resynchronization therapy

KW - heart failure

KW - left bundle branch block

KW - left bundle branch pacing

KW - left conduction system

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Cardiac Resynchronization Therapy in Patients With Nonischemic Cardiomyopathy Using Left Bundle Branch Pacing

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