Comparable acute hemodynamic effects of left bundle branch pacing delivered from the right and left ventricular septum
A Liew, N Wijesuriya, S Howell, F Devere, J Whitaker, S Niederer, C A RinaldiAbstract
Background
Left bundle branch area pacing (LBBAP) is conventionally performed from the right ventricular septum. The haemodynamic effect of LBBAP delivered from the LV septum (L-LBBAP) compared to right-sided LBBAP (R-LBBAP) has not been studied. We assessed the acute hemodynamic effects of L-LBBAP and R-LBBAP.
Methods
Eight patients were implanted with a permanent LBBAP and underwent invasive temporary pacing and hemodynamic testing with measurement of the maximum rate of left ventricular (LV dp/dtmax) and of right ventricular pressure rise (RV dp/dtmax). R-LBBAP was performed using the permanent LBBAP device in situ and L-LBBAP was performed using a temporary catheter within the left ventricle.
Results
There was no significant difference in the mean increase in ∆ LV dp/dtmax compared to baseline between R-LBBAP and L-LBBAP (72.1 ± 128.6 mmHg/s vs. 99.1 ± 148.1 mmHg/s respectively; P = 0.51). Similarly, ∆ RV dp/dtmax did not differ significantly between R-LBBAP and L-LBBAP (-21.1 ± 22.7 mmHg/s vs. -22.8 ± 17.1 mmHg/s, respectively; P = 0.95). The mean QRS duration reduction was 25.4 ± 10.0ms and 31.6 ± 5.7ms for R-LBBAP and L-LBBAP respectively (P = 0.60).
Conclusion
Both R-LBBAP and L-LBBAP produced comparable effects on biventricular hemodynamics and QRS reduction. Both improved LV contractility at the expense of RV contractility.