Comparison of methods for delivering cardiac resynchronization therapy: an acute electrical and haemodynamic within-patient comparison of left bundle branch area, His bundle, and biventricular pacing.

Autor:	Ali N; Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Du Cane Road, London W120HS, UK., Arnold AD; Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Du Cane Road, London W120HS, UK., Miyazawa AA; Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Du Cane Road, London W120HS, UK., Keene D; Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Du Cane Road, London W120HS, UK., Chow JJ; Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Du Cane Road, London W120HS, UK., Little I; Medtronic Limited, Building 9, Croxley Green Business Park, Watford WD18 8WW, UK., Peters NS; Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Du Cane Road, London W120HS, UK., Kanagaratnam P; Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Du Cane Road, London W120HS, UK., Qureshi N; Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Du Cane Road, London W120HS, UK., Ng FS; Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Du Cane Road, London W120HS, UK., Linton NWF; Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Du Cane Road, London W120HS, UK., Lefroy DC; Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Du Cane Road, London W120HS, UK., Francis DP; Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Du Cane Road, London W120HS, UK.; Department of Cardiology, St Richards Hospital, University Hospitals Sussex NHS Foundation Trust., Spitalfield Ln, Chichester PO19 6SE, UK., Phang Boon L; Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Du Cane Road, London W120HS, UK., Tanner MA; Department of Cardiology, St Richards Hospital, University Hospitals Sussex NHS Foundation Trust., Spitalfield Ln, Chichester PO19 6SE, UK., Muthumala A; Department of Cardiology, St Bartholomew's Hospital and North Middlesex University Hospital, W Smithfield, London EC1A 7BE, UK., Shun-Shin MJ; Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Du Cane Road, London W120HS, UK., Cole GD; Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Du Cane Road, London W120HS, UK., Whinnett ZI; Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Du Cane Road, London W120HS, UK.
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2023 Mar 30; Vol. 25 (3), pp. 1060-1067.
DOI:	10.1093/europace/euac245
Abstrakt:	Aims: Left bundle branch area pacing (LBBAP) is a promising method for delivering cardiac resynchronization therapy (CRT), but its relative physiological effectiveness compared with His bundle pacing (HBP) is unknown. We conducted a within-patient comparison of HBP, LBBAP, and biventricular pacing (BVP). Methods and Results: Patients referred for CRT were recruited. We assessed electrical response using non-invasive mapping, and acute haemodynamic response using a high-precision haemodynamic protocol. Nineteen patients were recruited: 14 male, mean LVEF of 30%. Twelve had time for BVP measurements. All three modalities reduced total ventricular activation time (TVAT), (ΔTVATHBP -43 ± 14 ms and ΔTVATLBBAP -35 ± 20 ms vs. ΔTVATBVP -19 ± 30 ms, P = 0.03 and P = 0.1, respectively). HBP produced a significantly greater reduction in TVAT compared with LBBAP in all 19 patients (-46 ± 15 ms, -36 ± 17 ms, P = 0.03). His bundle pacing and LBBAP reduced left ventricular activation time (LVAT) more than BVP (ΔLVATHBP -43 ± 16 ms, P < 0.01 vs. BVP, ΔLVATLBBAP -45 ± 17 ms, P < 0.01 vs. BVP, ΔLVATBVP -13 ± 36 ms), with no difference between HBP and LBBAP (P = 0.65). Acute systolic blood pressure was increased by all three modalities. In the 12 with BVP, greater improvement was seen with HBP and LBBAP (6.4 ± 3.8 mmHg BVP, 8.1 ± 3.8 mmHg HBP, P = 0.02 vs. BVP and 8.4 ± 8.2 mmHg for LBBAP, P = 0.3 vs. BVP), with no difference between HBP and LBBAP (P = 0.8). Conclusion: HBP delivered better ventricular resynchronization than LBBAP because right ventricular activation was slower during LBBAP. But LBBAP was not inferior to HBP with respect to LV electrical resynchronization and acute haemodynamic response. Competing Interests: Conflict of interest: None declared. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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