Mechanical Synchrony and Myocardial Work in Heart Failure Patients With Left Bundle Branch Area Pacing and Comparison With Biventricular Pacing

Wen Liu; Wen Liu; Wen Liu; Chunqiang Hu; Chunqiang Hu; Chunqiang Hu; Yanan Wang; Yanan Wang; Yanan Wang; Yufei Cheng; Yufei Cheng; Yufei Cheng; Yingjie Zhao; Yingjie Zhao; Yingjie Zhao; Yang Liu; Yang Liu; Yang Liu; Shaoxin Zheng; Haiyan Chen; Haiyan Chen; Haiyan Chen; Xianhong Shu; Xianhong Shu; Xianhong Shu; Xianhong Shu

doi:10.3389/fcvm.2021.727611

Frontiers in Cardiovascular Medicine (Aug 2021)

Mechanical Synchrony and Myocardial Work in Heart Failure Patients With Left Bundle Branch Area Pacing and Comparison With Biventricular Pacing

Wen Liu,
Wen Liu,
Wen Liu,
Chunqiang Hu,
Chunqiang Hu,
Chunqiang Hu,
Yanan Wang,
Yanan Wang,
Yanan Wang,
Yufei Cheng,
Yufei Cheng,
Yufei Cheng,
Yingjie Zhao,
Yingjie Zhao,
Yingjie Zhao,
Yang Liu,
Yang Liu,
Yang Liu,
Shaoxin Zheng,
Haiyan Chen,
Haiyan Chen,
Haiyan Chen,
Xianhong Shu,
Xianhong Shu,
Xianhong Shu,
Xianhong Shu

Affiliations

Wen Liu: Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China
Wen Liu: Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
Wen Liu: Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
Chunqiang Hu: Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China
Chunqiang Hu: Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
Chunqiang Hu: Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
Yanan Wang: Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China
Yanan Wang: Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
Yanan Wang: Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
Yufei Cheng: Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China
Yufei Cheng: Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
Yufei Cheng: Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
Yingjie Zhao: Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China
Yingjie Zhao: Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
Yingjie Zhao: Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
Yang Liu: Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China
Yang Liu: Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
Yang Liu: Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
Shaoxin Zheng: Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Haiyan Chen: Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China
Haiyan Chen: Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
Haiyan Chen: Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
Xianhong Shu: Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China
Xianhong Shu: Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
Xianhong Shu: Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
Xianhong Shu: Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China

DOI: https://doi.org/10.3389/fcvm.2021.727611
Journal volume & issue: Vol. 8

Abstract

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Background: Little is known about the efficacy of permanent left bundle branch area pacing (LBBAP) in delivering cardiac resynchronization therapy (CRT). This study aimed to evaluate the effect of LBBAP on mechanical synchronization and myocardial work (MW) in heart failure (HF) patients and to compare LBBAP with biventricular pacing (BVP).Methods: This is a multicenter, prospective cohort study. From February 2018 to January 2021, 62 consecutive HF patients with reduced ejection fraction (LVEF ≤ 35%) and complete left bundle branch block (CLBBB) who underwent LBBAP or BVP were enrolled in this study. Echocardiograms and electrocardiograms and were conducted before and 3–6 months after implantation. Intra- and interventricular synchronization were assessed using two-dimensional speckle tracking imaging (2D-STI). The left ventricular pressure-strain loop was obtained by combining left ventricular strain with non-invasive blood pressure to evaluate mechanical efficiency.Results: The echocardiographic response rates were 68.6 and 88.9% in the BVP and LBBAP groups, respectively. Left bundle branch area pacing resulted in significant QRS narrowing (from 177.1 ± 16.7 to 113.0 ± 18.4 ms, P < 0.001) and improvement in LVEF (from 29.9 ± 4.8 to 47.1 ± 8.3%, P < 0.001). The global wasted work (GWW) (410.3 ± 166.6 vs. 283.0 ± 129.6 mmHg%, P = 0.001) and global work efficiency (GWE) (64.6 ± 7.8 vs. 80.5 ± 5.7%, P < 0.001) were significantly improved along with shorter peak strain dispersion (PSD) (143.4 ± 45.2 vs. 92.6 ± 35.1 ms, P < 0.001) and interventricular mechanical delay (IVMD) (56.4 ± 28.5 vs. 28.9 ± 19.0 ms, P < 0.001), indicating its efficiency in improving mechanical synchronization. In comparison with BVP, LBBAP delivered greater improvement of QRS narrowing (−64.1 ± 18.9 vs. −32.5 ± 22.3 ms, P < 0.001) and better mechanical synchronization and efficiency.Conclusions: Left bundle branch area pacing was effective in improving cardiac function, mechanical synchronization, and mechanical efficiency and may be a promising alternative cardiac resynchronization therapy.

Published in Frontiers in Cardiovascular Medicine

ISSN: 2297-055X (Online)
Publisher: Frontiers Media S.A.
Country of publisher: Switzerland
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.frontiersin.org/journals/cardiovascular-medicine

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