Comparision Of Left Bundle Branch Pacing And Biventricular Pacing In Patients With Chronic Heart Failure

Objective To compare pacing parameters,cardiac functions,pacing parameters,cardiac structure,cardiac electromechanical synchrony,and clinical prognosis between cardiac resynchronization therapy(CRT)with left bundle branch pacing(LBBP)and biventricular pacing(BVP).And analyze efficacy and safety of LBBP in patients with chronic heart failure.Methods A retrospective analysis was performed on 30 heart failure(HF)patients undergoing permanent CRT in the Department of Cardiology,Affiliated Hospital of Qingdao University from June 2018 to August 2020.The patients were divided into left bundle branch pacing CRT group(LBBP-CRT group,n=15)and biventricular pacing CRT group(BVP-CRT group,n=15)according to pacing mode.Clinical data of cardiac function,ventricular pacing parameters,12-lead electrocardiogram,echocardiogram,and pacemaker-related complications were collected preoperative and 1,3,and 6 months after operation.The difference of each index including NYHA heart function,ventricular pacing threshold,ventricular R wave perception,ventricular lead impedance,left atrial ejection fraction(LAEF),mitral regurgitation area(MRA),left atrial volume index(LAVI),left ventricular ejection fraction(LVEF),left ventricular end-diastolic dimension(LVEDD),tricuspid annular plane systolic excursion(TAPSE),right ventricular anteroposterior diameter(RVD),pulmonary artery pressure(PASP),QRS duration,inter-ventricular mechanical delay(IVMD),septal to posterior wall mechanical delay(SPWMD),CRT-related complications,new occurrence of atrial fibrillation,heart failure rehospitalization,and death were compared.The statistical data were processed using SPSS 22.0 statistical software.P < 0.05 indicated statistically significant difference.Results(1)There was no statistical difference in age,gender,etiology and other baseline information between the two groups.(2)The two groups of NYHA heart function,LAEF,LAVI,MRA,LVEF,LVEDD,TAPSE,RVD,PASP,QRS duration,IVMD and SPWMD had time effects(F=2.85~102.86,P<0.05).In addition,ventricular pacing threshold,QRS duration,IVMD and SPWMD had group effects(F=26.08、5.12、18.21、60.33,P<0.05),only IVMD and SPWMD had interactive effects(F=41.24、81.60,P<0.01).(3)The LAEF in LBBP-CRT group increased 6 months after surgery compared with that before surgery(F=9.56,P<0.01).(3)The NYHA heart function of 2 groups at 1,3 and 6 months after surgery were higher than that before surgery(F=4.03~7.99,P<0.01).The LAEF in LBBP-CRT group was significantly increased at 6 months after surgery compared with that before surgery(F=9.56,P< 0.01).The MRA of 2 groups at 3 and 6 months after surgery was significantly lower than that before surgery(F=12.32~12.98,P<0.01).In the LBBP-CRT group,the LVEF at 3and 6 months after surgery was significantly higher than that before surgery(F=6.62,8.10,P<0.01).In the BVP-CRT group,the LVEF at 6 months after surgery was significantly higher than that before surgery(F=4.91,P<0.01).The TAPSE in both groups was increased significantly 3 and 6 months after operation compared with that before operation(F=2.48~4.97,P< 0.05).In LBBP-CRT group,the PASP at 1,3 and 6 months after surgery was significantly lower than that before surgery(F=5.26,6.26,6.57,P< 0.01),and in BVP-CRT group,the PASP at 3 and 6 months after surgery was significantly lower than that before surgery(F=2.63,3.40,P < 0.05).The QRS duration,IVMD and SPWMD at 1,3 and 6months after surgery were all shorter than those before surgery(F= 5.27~17.23,P< 0.01).(4)The ventricular pacing threshold in LBBP-CRT group was higher than that in BVP-CRT group at 1,3 and 6 months after surgery,and the difference was statistically significant(F=4.83,5.04,5.37,5.17,P< 0.05).At 1,3 and 6 months after treatment,the QRS duration,IVMD and SPWMD in LBBP-CRT group were shorter than those in BVP-CRT group,the differences were statistically significant(F= 2.53-10.04,P< 0.05).(5)During the follow-up period of 6 months,no complications were found in both groups such as pacemaker pocket infection,lead thrombosis,stroke,lead dislocation,cardiac perforation,ventricular septal perforation,pericardial tamponade,etc.(6)One patient in the BVP-CRT group was re-admitted to hospital due to worsening heart failure 4 months after surgery.There were no new atrial fibrillation or death in either group.Conclusions LBBP-CRT significantly improved left atrium,left ventricle,and right ventricle function in patients with chronic heart failure,and kept pacing parameters stable in the short term follow-up.However,the structure of left atrium,right ventricle,and left ventricle did not improve significantly in short term after operation.At the same time,LBBP is superior in improving cardiac electromechanical synchronization than BVP-CRT.