Application Of Left Bundle Branch Area Pacing In Patients With Left Bundle Branch Block Pacemaker Indication

Objectives:The purpose of this study is to observe the safety and effectiveness of left bundle branch area pacing(LBBP)in patients with pacemaker indications combined with left bundle branch block(LBBB).Method:Selected patients with pacemaker implantation indications for LBBP who combined LBBB from May 2019 to August 2020 in our hospital.Mainly collect baseline data of all the above patients and preoperative plasma NT-pro BNP concentration,electrocardiogram,cardiac color Doppler ultrasound,NYHA cardiac function classification,and record intraoperative electrode pacing parameters(threshold,impedance,perception)and left bundle branch unipolar pacing Peak time.All patients were programmed to the ventricular unipolar pacing mode before discharge,keeping the ventricular pacing ratio greater than 90%.Followup visit to our hospital’s cardiology department arrhythmia clinic in the first month,third month,and sixth month after pacemaker implantation,to review plasma NT-pro BNP concentration measurement,ECG examination,chest X-ray,echocardiography,NYHA cardiac function Graded assessment,pacemaker program-controlled review of ventricular electrode pacing parameter changes(perception,threshold,impedance),and adjust and optimize the parameters as appropriate according to the patient’s condition.Preliminary assessment for comp lications such as swelling and infection at the capsular bag,lead dislocation,ventricular septal perforation,pneumothorax,pericardial effu sion,thromboembolism,pacemaker syndrome,as well as posto perative re-admission and death.Compare changes in pacing electrode parameters of all patients,QRS time limit,plasma NT-pro BNP concentration,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),NYHA cardiac function classification before operation,intraoperative and postoperative whether there is any difference,and discuss and analyze.Results:1.A total of 28 patients were enrolled,including 10 males and 18 females,with an average age of(67.5 ± 10.5)years.There were 16 LBBB patients with LVEF<50%,and 12 LBBB patients with LVEF>50%(1patient with sick sinus syndrome,11 patients with atrioventricular block).All patients had LBBB on ECG(including complete and incomplete LBBB).The above patients have completed to 6 months follow-up.During the follow-up period,there were no common complications such as swelling,infection,lead dislocation,ventricular septal perforation,pneumothorax,pericardial effusion,thromboembolism,and pacemaker syndrome.During the follow-up period,there were no re-admissions or deaths.2.Preoperative,intraoperative,and postoperative index results:(1)Electrode parameters: compared with intraoperatively in the first month,third month,and sixth month after surgery,there was no significant difference in threshold,impedance,and perception(P>0.05),all electrode parameters remain relatively stable.(2)Electrocardiogram: QRS wave showed right bundle branch block after operation(RBBB).The QRS duration of the first month,the third month,and the sixth month after the operation were significantly narrower compared with those before the operation(P<0.05).(3)Plasma NT-pro BNP concentration and NYHA heart function classification were significantly improved in the first month,third month,and sixth month after surgery(P<0.05).(4)Echocardiographic indicators: In patients with LVEF>50%,there were no significant differences in LVEF,LVEDD,and LVESD in the first month,third month,and sixth month after surgery(P>0.05).In patients with LVEF<50%,the LVEF in the first month,third month,and sixth month after surgery was significantly improved compared with that before surgery(P<0.05).There was no significant difference in LVEDD and LVESD in the first month after surgery(P>0.05).The LVEDD and LVESD in the 3rd and 6th months after operation were improved compared with those before the operation(P<0.05).conclusion:For patients with pacemaker indications combined with LBBB,LBBP,as a new physiological pacing strategy,is clinically safe and feasible.It has important value in correcting LBBB and can improve left ventricular synchrony.Structure and function have a certain degree of improvement.