Left Bundle Branch Pacing: Current Knowledge and Future Prospects
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TLDR
In this paper, the authors discuss the current knowledge of left bundle branch pacing (LBBP) and discuss its feasibility and safety, with rare complications and high success rate, and discuss the potential of LBBP as a potential alternative pacing modality for both RVAP and cardiac resynchronization therapy with HBP or BVP.Abstract:
Cardiac pacing is an effective therapy for treating patients with bradycardia due to sinus node dysfunction or atrioventricular block. However, traditional right ventricular apical pacing (RVAP) causes electric and mechanical dyssynchrony, which is associated with increased risk for atrial arrhythmias and heart failure. Therefore, there is a need to develop a physiological pacing approach that activates the normal cardiac conduction and provides synchronized contraction of ventricles. Although His bundle pacing (HBP) has been widely used as a physiological pacing modality, it is limited by challenging implantation technique, unsatisfactory success rate in patients with wide QRS wave, high pacing capture threshold, and early battery depletion. Recently, the left bundle branch pacing (LBBP), defined as the capture of left bundle branch (LBB) via transventricular septal approach, has emerged as a newly physiological pacing modality. Results from early clinical studies have demonstrated LBBP's feasibility and safety, with rare complications and high success rate. Overall, this approach has been found to provide physiological pacing that guarantees electrical synchrony of the left ventricle with low pacing threshold. This was previously specifically characterized by narrow paced QRS duration, large R waves, fast synchronized left ventricular activation, and correction of left bundle branch block. Therefore, LBBP may be a potential alternative pacing modality for both RVAP and cardiac resynchronization therapy with HBP or biventricular pacing (BVP). However, the technique's widespread adaptation needs further validation to ascertain its safety and efficacy in randomized clinical trials. In this review, we discuss the current knowledge of LBBP.read more
Citations
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Comparative effects of left bundle branch area pacing, His bundle pacing, biventricular pacing in patients requiring cardiac resynchronization therapy: A network meta‐analysis
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TL;DR: The comparative effects of different types of cardiac resynchronization therapy (CRT) delivered by biventricular pacing, His bundle pacing (HBP), and left bundle branch area pacing (LBBAP) remain inconclusive.
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References
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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.
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TL;DR: Authors/Task Force Members: Piotr Ponikowski* (Chairperson) (Poland), Adriaan A. Voors* (Co-Chair person) (The Netherlands), Stefan D. Anker (Germany), Héctor Bueno (Spain), John G. F. Cleland (UK), Andrew J. S. Coats (UK)
Journal ArticleDOI
2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
Piotr Ponikowski,Adriaan A. Voors,Stefan D. Anker,Héctor Bueno,John G.F. Cleland,Andrew J.S. Coats,Volkmar Falk,José Ramón González-Juanatey,Veli-Pekka Harjola,Ewa A. Jankowska,Mariell Jessup,Cecilia Linde,Petros Nihoyannopoulos,John Parissis,Burkert Pieske,Jillian P. Riley,Giuseppe M.C. Rosano,Luis M. Ruilope,Frank Ruschitzka,Frans H. Rutten,Peter van der Meer +20 more
TL;DR: ACCF/AHAIAI: angiotensin-converting enzyme inhibitor as discussed by the authors, angio-catabolizing enzyme inhibitor inhibitor inhibitor (ACS inhibitor) is a drug that is used to prevent atrial fibrillation.
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The effect of cardiac resynchronization on morbidity and mortality in heart failure
John G.F. Cleland,Jean-Claude Daubert,Erland Erdmann,Nick Freemantle,Daniel Gras,Lukas Kappenberger,Luigi Tavazzi +6 more
TL;DR: Cardiac resynchronization has been shown to reduce symptoms and improve left ventricular function in patients with heart failure due to systolic dysfunction and cardiac dyssynchrony.
Journal ArticleDOI
Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial.
Bruce L. Wilkoff,James R. Cook,Andrew E. Epstein,Leon Greene,Alfred P. Hallstrom,Henry H. Hsia,Steven P. Kutalek,Arjun Sharma,Brian Blatt,Barry Karas,James Kirchhoffer,Deborah Warwick,Mary Duquette,Jean Provencher,Maureen Redmond,John M. Herre,Robert S. Bernstein,Linette R. Klevan,Kathleen D. Barackman,Jennine Zumbuhl,Mina K. Chung,Fredrick J. Jaeger,David O. Martin,Andrea Natale,Walid Saliba,Robert A. Schweikert,Mark Niebauer,Patrick J. Tchou,Raquel Rozich,Marc Roelke,Constantinos A. Costeas,Donald G. Rubenstein,Scott Ruffo,Kelly Kumar,Elizabeth McCarthy,Valerie Pastore,Mark S. Wathen,Jeffrey N. Rottman,Mark Anderson,John T. Lee,Katherine T. Murray,Dan M. Roden,Nancy Conners,Sandy Saunders,Gearoid P. O'Neill,Anne Skadsen,Shelley Allen,Ellie Vierra,Stephen Greer,Jeffrey Neuhauser,Pam Myers,Celeste Lee,Terri Moore,Richard C. Klein,Roger A. Freedman,Geri Wadsworth,Sharon M. Dailey,G. Neal Kay,Vance J. Plumb,Rosemary S. Bubien,Linda W. Kay,Candace M. Nasser,Jane E. Slabaugh,Robert B. Leman,Jenifer L. Lake,Julie Clark,Elizabeth Clarke,Laura Finklea,John C. Love,Charles M. Carpenter,Andrew Corsello,Joel E. Cutler,Susan BosworthFarrell,Gregory Michaud,Alfred E. Buxton,Kristin E. Ellison,Frederic Christian,Malcolm Kirk,Pamela L. Corcoran,Stephen T. Rothbart,Roy B. Sauberman,Jennifer McCarthy,Mary Ellen Page,Jonathan S. Steinberg,Frederick Ehlert,Bengt Herweg,Margot Vloka,Ammy Malinay,Edith Menchavez,Michael Rome,Kathy Marks,Alison Swarens,Maribel Hernandez,Roger A. Marinchak,Douglas Esberg,John Finkle,Glenn Harper,Peter R. Kowey,Colin Movsowitz +98 more
TL;DR: For patients with standard indications for ICD therapy, no indication for cardiac pacing, and an LVEF of 40% or less, dual-chamber pacing offers no clinical advantage over ventricular backup pacing and may be detrimental by increasing the combined end point of death or hospitalization for heart failure.
Journal ArticleDOI
Adverse Effect of Ventricular Pacing on Heart Failure and Atrial Fibrillation Among Patients With Normal Baseline QRS Duration in a Clinical Trial of Pacemaker Therapy for Sinus Node Dysfunction
Michael O. Sweeney,Anne S. Hellkamp,Kenneth A. Ellenbogen,Arnold J. Greenspon,Roger A. Freedman,Kerry L. Lee,Gervasio A. Lamas +6 more
TL;DR: Ventricular desynchronization imposed by ventricular pacing even when AV synchrony is preserved increases the risk of HF hospitalization and AF in SND with normal baseline QRSd.