Comparison Of Left Bundle Branch Pacing And Right Ventricular Pacing In Patients With Third Degree Atrioventricular Block

Objective To compare the electromechanical synchrony and clinical prognosis between left bundle branch pacing and right ventricular septal pacing,and evaluate the feasibility,safety and advantages of left bundle branch pacing in patients with third degree atrioventricular block.Methods A total of 100 patients with third degree atrioventricular block requiring permanent pacing treatment from January 2019 to March 2020 in cardiology department of Qingdao University affiliated Hospital were randomly divided into 2 groups with Random Number Table,and then operating left bundle branch pacing and right ventricular septal pacing respectively.The left ventricular 12 segment Ts standard deviation(Tsd-12-LV),pacing parameters,QRS duration(QRSd)),QTc interval,left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),left ventricular lateral wall basal segment and right ventricular free wall basal systolic velocity peak time(Ts)(Ts-LV-RV),and left ventricular filling time and RR interval ratio(LVFT/RR)were followed up and compared between the two groups.The SPSS 22.0 system was used to analyze the data,and the difference was statistically significant with P<0.05.Results(1)A total of 100 patients with third-degree atrioventricular block were collected,and then recepted permanent pacemaker implantation.Fifty cases of left bundle branch pacing and 50 cases of right ventricular septal pacing were successfully performed.The average age of the patients in the left bundle branch pacing group was(61.92±9.53)years,and there were 24 males in the group.The average age of the patients in the right ventricular septal pacing group was(65.12±8.94)years,and there were 25 males in the group.(2)Pacing threshold,perception and impedance changes were stable after operation,and there was no significant difference between the LBBP group and RVSP group.(3)Compared with preoperative parameters,there was no statistically significant difference in Tsd-12-LV in the left bundle branch pacing group(P>0.05);The Tsd-12-LV of right ventricular septal pacing group changed from(29.06±5.57)ms to(33.64±6.89)ms.Ts-LV-RV and LVFT/RR in the left bundle branch pacing group showed statistical significance compared with preoperative parameters(P<0.05).There was no statistical significance in Ts-LV-RV of the right ventricular septal pacing group(P=0.38);At the last follow-up,the difference in Ts-LV-RV between the LBBP group and RVSP group was statistically significant(P<0.05).The LVFT/RR in RVSP group was more satisfying than baseline parameters(P<0.05),the difference between the LBBP group and RVSP group was statistically significant at the last follow-up(P<0.05).There was no statistically significant difference in LVEF of the RVSP group or the LBBP group at 6 months after the operation compared with baseline parameters(P>0.05),and the difference between the two groups was not statistically significant(P=0.07).There was no significant difference in LVEDD of the RVSP group or the LBBP group compared with baseline parameters(P>0.05),and there was no significant difference in LVEDD between the two groups at 6 months after operation(P=0.32).The QRSd in the LBBP group improved from(120.22±22.61)ms to(110.00±10.96)ms 6 months after surgery,and the RVSP group increased from(119.20±25.24)ms to(144.60±12.49)ms,the difference between the two groups was statistically significant(P<0.05).There was no significant difference in QTc interval of the RVSP group or the LBBP group compared with the preoperative period(P>0.05),but the difference between the two groups at the last follow-up after operation was statistically significant(P<0.05).(4)During the follow-up period,no patient suffered complications such as myocardial perforation,capsular hemorrhage and lead dislocation,and no recurrence of heart failure,tachyarrhythmia hospitalization,death or other pacing related events.Conclusions Left bundle branch pacing is better than right ventricular septal pacing in improving the electrical and mechanical synchronization of patients with third-degree atrioventricular block,.The pacing parameters are stable during the operation and half-year follow-up of left bundle branch pacing.It is a safe and feasible physiological pacing treatment strategy.