Left ventricular septal pacing improved LVEF from 26.7% to 38.8%, reduced LV end-diastolic diameter from 67.9 mm to 59.7 mm, and improved NYHA class and NT-proBNP over 29.4 months in heart failure patients with LBBB.
Observational (n=40)
No
Does left ventricular septal pacing (LVSP) improve QRS duration, cardiac function, and clinical symptoms in patients with a cardiac resynchronization therapy indication?
Permanent left ventricular septal pacing is safe, feasible, and results in significant improvements in clinical symptoms and echocardiographic reverse remodeling in patients with systolic heart failure and LBBB.
Effect estimate: LVEF improvement from 26.7% to 38.8% (P<0.001)
Absolute Event Rate: 38.8% vs 26.7%
p-value: p=<0.001
Background Left bundle branch area pacing (LBBAP) is considered to be an alternative modality to deliver cardiac resynchronization therapy (CRT). However, left bundle branch pacing and left ventricular septal pacing (LVSP) are characterized as left bundle branch area pacing. The long‐term effect of only LVSP in patients with a CRT indication is still unknown. Methods Consecutive patients who met the CRT indication were retrospectively included. LVSP was determined during the procedure. New York Heart Association functional class, NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), and echocardiographic and pacing parameters were assessed at implant and follow‐up visit. Results A total of 40 consecutive patients with successful LVSP were included for analysis with a mean follow‐up period of 29.4±16.2 months. The QRS complex in lead V 1 during LVSP featured a QS pattern (52.5%), Qr/qR pattern (30%), or rsR pattern (17.5%). LVSP significantly shortened QRS duration (from baseline 172.5±16.8 to 135.3±19.8 ms, P <0.001) with V 6 R‐wave peak time of 96.4±9.6 ms. Left ventricular ejection fraction mproved from 26.7±7.4% at baseline to 38.8±16.1% ( P <0.001) and a decrease in the LV end‐diastolic diameter (67.9±9.8 versus 59.7±10.4 mm; P <0.001) during the follow‐up. Echocardiographic response and superresponse were observed in 52.5% and 22.5% of patients, respectively. New York Heart Association functional class improved from 2.7±0.4 at baseline to 1.9±0.6 ( P <0.01) and NT‐proBNP concentration decreased significantly (4544±975 versus 2353±1225 pg/mL; P <0.001). No procedure‐related complications occurred during the implantation procedure. Conclusions LVSP is clinically feasible and safe in patients undergoing CRT. LVSP appears to be an alternative CRT pacing strategy with suboptimal ventricular resynchronization.
Wei et al. (Thu,) conducted a observational in Patients with systolic heart failure and left bundle branch block (LBBB) with indication for cardiac resynchronization therapy (CRT) (n=40). Left ventricular septal pacing (LVSP) was evaluated on Change in left ventricular ejection fraction (LVEF) and LV end-diastolic diameter (LVDd) after LVSP with clinical and echocardiographic response (LVEF improvement from 26.7% to 38.8% (P<0.001), p=<0.001). Left ventricular septal pacing improved LVEF from 26.7% to 38.8%, reduced LV end-diastolic diameter from 67.9 mm to 59.7 mm, and improved NYHA class and NT-proBNP over 29.4 months in heart failure patients with LBBB.