Comparison of Left Ventricular Function after His Bundle Pacing vs Left Bundle Branch Area Pacing Implantation

  • Kurniawan Prakoso Department of Cardiology and Vascular Medicine, Hasan Sadikin, General Hospital, Universitas Padjadjaran, Bandung, Indonesia.
  • Kevin Wibawa Department of Cardiology and Vascular Medicine, Hasan Sadikin, General Hospital, Universitas Padjadjaran, Bandung, Indonesia. https://orcid.org/0000-0003-2975-1900
  • Giky Karwiky Department of Cardiology and Vascular Medicine, Hasan Sadikin, General Hospital, Universitas Padjadjaran, Bandung, Indonesia. https://orcid.org/0000-0002-8327-1564
  • Mohammad Rizki Akbar Department of Cardiology and Vascular Medicine, Hasan Sadikin, General Hospital, Universitas Padjadjaran, Bandung, Indonesia. https://orcid.org/0000-0001-9662-8676
  • Januar Wibawa Martha Department of Cardiology and Vascular Medicine, Hasan Sadikin, General Hospital, Universitas Padjadjaran, Bandung, Indonesia. https://orcid.org/0000-0001-8993-3197
  • Mohammad Iqbal Department of Cardiology and Vascular Medicine, Hasan Sadikin, General Hospital, Universitas Padjadjaran, Bandung, Indonesia. https://orcid.org/0000-0003-1343-8207
Keywords: conduction system pacing (CSP), his bundle pacing (HBP), left bundle branch area pacing (LBBAP), left ventricular (LV) function

Abstract

Background: Right ventricular pacing may lead to deterioration of left ventricular (LV) function. Recent guideline suggests the use of conduction system pacing (CSP) with either his bundle pacing (HBP) or left bundle branch area pacing (LBBAP). This study aimed to investigate the difference of LV function between HBP and LBBAP.

Methods: This is a prospective cohort study enrolling patients age >18 years requiring CSP implantation from June 2020 to January 2024 in Hasan Sadikin General Hospital, Bandung. Data regarding QRS duration and several echocardiography parameters were obtained at baseline and during follow up within 1 year after CSP implantation.

Results: From 66 patients, 35 were included in the HBP group. There was no difference in QRS duration at baseline between both groups with higher left ventricular ejection fraction (LVEF) in HBP group (51.2 ± 13.9% vs 45.6 ± 11.1%, p=0.078). During follow up, HBP group showed narrower QRS duration (113.40 ± 17.06ms vs 120.81 ± 12.12ms, p=0.029). LV function was preserved in HBP group while there was a trend of LV function improvement in LBBAP group (53.1 ± 11.7% in LBBAP vs 53.9 ± 11.5% in HBP group, p=0.536). Further analysis in 33 patients with LV dysfunction showed a trend of LVEF improvement in both groups (35.3 ± 7.9% to 44.6 ± 11.28% in HBP and 38.7 ± 6.9% to 51.4 ± 13.1% in LBBAP group).

Conclusion: HBP resulted in narrower QRS complex. However, both HBP and LBBAP showed a trend of LV function improvement in patients with LV dysfunction.

Downloads

Download data is not yet available.

References

1. Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM; ESC Scientific Document Group. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021 Sep 14;42(35):3427-3520. doi: 10.1093/eurheartj/ehab364. Erratum in: Eur Heart J. 2022 May 1;43(17):1651. PMID: 34455430.
2. Khurshid S, Epstein AE, Verdino RJ, Lin D, Goldberg LR, Marchlinski FE, Frankel DS. Incidence and predictors of right ventricular pacing-induced cardiomyopathy. Heart Rhythm. 2014 Sep;11(9):1619-25. doi: 10.1016/j.hrthm.2014.05.040. Epub 2014 Jun 2. PMID: 24893122.
3. Kiehl EL, Makki T, Kumar R, Gumber D, Kwon DH, Rickard JW, Kanj M, Wazni OM, Saliba WI, Varma N, Wilkoff BL, Cantillon DJ. Incidence and predictors of right ventricular pacing-induced cardiomyopathy in patients with complete atrioventricular block and preserved left ventricular systolic function. Heart Rhythm. 2016 Dec;13(12):2272-2278. doi: 10.1016/j.hrthm.2016.09.027. PMID: 27855853.
4. Chung MK, Patton KK, Lau CP, Dal Forno ARJ, Al-Khatib SM, Arora V, Birgersdotter-Green UM, Cha YM, Chung EH, Cronin EM, Curtis AB, Cygankiewicz I, Dandamudi G, Dubin AM, Ensch DP, Glotzer TV, Gold MR, Goldberger ZD, Gopinathannair R, Gorodeski EZ, Gutierrez A, Guzman JC, Huang W, Imrey PB, Indik JH, Karim S, Karpawich PP, Khaykin Y, Kiehl EL, Kron J, Kutyifa V, Link MS, Marine JE, Mullens W, Park SJ, Parkash R, Patete MF, Pathak RK, Perona CA, Rickard J, Schoenfeld MH, Seow SC, Shen WK, Shoda M, Singh JP, Slotwiner DJ, Sridhar ARM, Srivatsa UN, Stecker EC, Tanawuttiwat T, Tang WHW, Tapias CA, Tracy CM, Upadhyay GA, Varma N, Vernooy K, Vijayaraman P, Worsnick SA, Zareba W, Zeitler EP. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. Heart Rhythm. 2023 Sep;20(9):e17-e91. doi: 10.1016/j.hrthm.2023.03.1538. Epub 2023 May 20. PMID: 37283271.
5. Arnold AD, Whinnett ZI, Vijayaraman P. His-Purkinje Conduction System Pacing: State of the Art in 2020. Arrhythm Electrophysiol Rev. 2020 Nov;9(3):136-145. doi: 10.15420/aer.2020.14. PMID: 33240509; PMCID: PMC7675135.
6. Zhuang L, Mao Y, Wu L, Niu W, Chen K. Effects of right ventricular septum or His-bundle pacing versus right ventricular apical pacing on cardiac function: A systematic review and meta-analysis of randomized controlled trials. J Int Med Res. 2018 Sep;46(9):3848-3860. doi: 10.1177/0300060518781415. Epub 2018 Jul 1. PMID: 29962274; PMCID: PMC6136004.
7. Abdin A, Aktaa S, Vukadinović D, Arbelo E, Burri H, Glikson M, Meyer C, Munyombwe T, Nielsen JC, Ukena C, Vernooy K, Gale CP. Outcomes of conduction system pacing compared to right ventricular pacing as a primary strategy for treating bradyarrhythmia: systematic review and meta-analysis. Clin Res Cardiol. 2022 Nov;111(11):1198-1209. doi: 10.1007/s00392-021-01927-7. Epub 2021 Aug 19. PMID: 34410461; PMCID: PMC9622534.
8. Ravi V, Hanifin JL, Larsen T, Huang HD, Trohman RG, Sharma PS. Pros and Cons of Left Bundle Branch Pacing: A Single-Center Experience. Circ Arrhythm Electrophysiol. 2020 Dec;13(12):e008874. doi: 10.1161/CIRCEP.120.008874. Epub 2020 Nov 16. PMID: 33198496.
9. Deshmukh P, Casavant DA, Romanyshyn M, Anderson K. Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. Circulation. 2000 Feb 29;101(8):869-77. doi: 10.1161/01.cir.101.8.869. PMID: 10694526.
10. Hua W, Fan X, Li X, Niu H, Gu M, Ning X, Hu Y, Gold MR, Zhang S. Comparison of Left Bundle Branch and His Bundle Pacing in Bradycardia Patients. JACC Clin Electrophysiol. 2020 Oct;6(10):1291-1299. doi: 10.1016/j.jacep.2020.05.008. Epub 2020 Aug 12. PMID: 33092757.
11. Lewis AJM, Foley P, Whinnett Z, Keene D, Chandrasekaran B. His Bundle Pacing: A New Strategy for Physiological Ventricular Activation. J Am Heart Assoc. 2019 Mar 19;8(6):e010972. doi: 10.1161/JAHA.118.010972. Erratum in: J Am Heart Assoc. 2019 Jun 4;8(11):e002310. PMID: 30854911; PMCID: PMC6475060.
12. Thosani AJ, Liu E, Shaw G, Belden W, Chenarides J. Rapid reversal of right ventricular pacing-induced cardiomyopathy by His bundle pacing. HeartRhythm Case Rep. 2017 Jan 24;3(3):189-191. doi: 10.1016/j.hrcr.2017.01.004. PMID: 28791212; PMCID: PMC5532750.
13. Vijayaraman P, Naperkowski A, Subzposh FA, Abdelrahman M, Sharma PS, Oren JW, Dandamudi G, Ellenbogen KA. Permanent His-bundle pacing: Long-term lead performance and clinical outcomes. Heart Rhythm. 2018 May;15(5):696-702. doi: 10.1016/j.hrthm.2017.12.022. Epub 2017 Dec 20. PMID: 29274474.
14. Huang W, Su L, Wu S, Xu L, Xiao F, Zhou X, Ellenbogen KA. A Novel Pacing Strategy With Low and Stable Output: Pacing the Left Bundle Branch Immediately Beyond the Conduction Block. Can J Cardiol. 2017 Dec;33(12):1736.e1-1736.e3. doi: 10.1016/j.cjca.2017.09.013. Epub 2017 Sep 22. PMID: 29173611.
15. Vijayaraman P, Subzposh FA, Naperkowski A, Panikkath R, John K, Mascarenhas V, Bauch TD, Huang W. Prospective evaluation of feasibility and electrophysiologic and echocardiographic characteristics of left bundle branch area pacing. Heart Rhythm. 2019 Dec;16(12):1774-1782. doi: 10.1016/j.hrthm.2019.05.011. Epub 2019 May 25. PMID: 31136869.
16. Li X, Li H, Ma W, Ning X, Liang E, Pang K, Yao Y, Hua W, Zhang S, Fan X. Permanent left bundle branch area pacing for atrioventricular block: Feasibility, safety, and acute effect. Heart Rhythm. 2019 Dec;16(12):1766-1773. doi: 10.1016/j.hrthm.2019.04.043. Epub 2019 Apr 29. PMID: 31048065.
17. Tan ESJ, Soh R, Boey E, Lee JY, de Leon J, Chan SP, Gan HH, Seow SC, Kojodjojo P. Comparison of Pacing Performance and Clinical Outcomes Between Left Bundle Branch and His Bundle Pacing. JACC Clin Electrophysiol. 2023 Aug;9(8 Pt 1):1393-1403. doi: 10.1016/j.jacep.2022.12.022. Epub 2023 Feb 22. PMID: 37558292.
18. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021 Feb 1;42(5):373-498. doi: 10.1093/eurheartj/ehaa612. Erratum in: Eur Heart J. 2021 Feb 1;42(5):507. Erratum in: Eur Heart J. 2021 Feb 1;42(5):546-547. Erratum in: Eur Heart J. 2021 Oct 21;42(40):4194. PMID: 32860505.
19. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-3726. doi: 10.1093/eurheartj/ehab368. Erratum in: Eur Heart J. 2021 Oct 14;: PMID: 34447992.
20. Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. J Am Coll Cardiol. 2019 Aug 20;74(7):932-987. doi: 10.1016/j.jacc.2018.10.043. Epub 2018 Nov 6. Erratum in: J Am Coll Cardiol. 2019 Aug 20;74(7):1014-1016. PMID: 30412710.
21. Ezzeddine FM, Leon IG, Cha YM. Cardiac Resynchronisation with Conduction System Pacing. Arrhythm Electrophysiol Rev. 2023 Aug 11;12:e22. doi: 10.15420/aer.2023.03. PMID: 37654672; PMCID: PMC10466271.
22. Devabhaktuni S, Mar PL, Shirazi J, Dandamudi G. How to Perform His Bundle Pacing: Tools and Techniques. Card Electrophysiol Clin. 2018 Sep;10(3):495-502. doi: 10.1016/j.ccep.2018.05.008. PMID: 30172286.
23. Vijayaraman P, Subzposh FA, Naperkowski A, et al. Prospective evaluation of feasibility and electrophysiologic and echocardiographic characteristics of left bundle branch area pacing. Heart Rhythm 2019;16:1774–82.
24. Sundaram S, Vijayaraman P. Left bundle branch pacing. Herzschrittmacherther Elektrophysiol 2020;31:124–34.
25. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14. doi: 10.1016/j.echo.2014.10.003. PMID: 25559473.
26. Cheng A, Helm RH, Abraham TP. Pathophysiological mechanisms underlying ventricular dyssynchrony. Europace. 2009 Nov;11 Suppl 5:v10-14. doi: 10.1093/europace/eup272. PMID: 19861385.
27. Abdin A, Werner C, Burri H, Merino JL, Vukadinović D, Sawan N, Gajek J, Böhm M, Ukena C. Outcomes of left bundle branch area pacing compared to His bundle pacing as a primary pacing strategy: Systematic review and meta-analysis. Pacing Clin Electrophysiol. 2023 Nov;46(11):1315-1324. doi: 10.1111/pace.14836. Epub 2023 Oct 9. PMID: 37812167.
28. Byrne MJ, Helm RH, Daya S, Osman NF, Halperin HR, Berger RD, Kass DA, Lardo AC. Diminished left ventricular dyssynchrony and impact of resynchronization in failing hearts with right versus left bundle branch block. J Am Coll Cardiol. 2007 Oct 9;50(15):1484-90. doi: 10.1016/j.jacc.2007.07.011. Epub 2007 Sep 24. PMID: 17919569.
29. Tanaka H, Tanabe M, Simon MA, Starling RC, Markham D, Thohan V, Mather P, McNamara DM, Gorcsan J 3rd. Left ventricular mechanical dyssynchrony in acute onset cardiomyopathy: association of its resolution with improvements in ventricular function. JACC Cardiovasc Imaging. 2011 May;4(5):445-56. doi: 10.1016/j.jcmg.2011.02.012. PMID: 21565730.
30. Kronborg MB, Mortensen PT, Poulsen SH, Gerdes JC, Jensen HK, Nielsen JC. His or para-His pacing preserves left ventricular function in atrioventricular block: a double-blind, randomized, crossover study. Europace. 2014 Aug;16(8):1189-96. doi: 10.1093/europace/euu011. Epub 2014 Feb 7. PMID: 24509688.
31. Weizong W, Zhongsu W, Yujiao Z, Mei G, Jiangrong W, Yong Z, Xinxing X, Yinglong H. Effects of right ventricular nonapical pacing on cardiac function: a meta-analysis of randomized controlled trials. Pacing Clin Electrophysiol. 2013 Aug;36(8):1032-51. doi: 10.1111/pace.12112. Epub 2013 Feb 25. PMID: 23438131.
Published
2025-01-10
Views & Downloads
Abstract views: 172   
PDF downloads: 114   
How to Cite
Prakoso, K., Wibawa, K., Karwiky, G., Akbar, M., Martha, J., & Iqbal, M. (2025). Comparison of Left Ventricular Function after His Bundle Pacing vs Left Bundle Branch Area Pacing Implantation. Indonesian Journal of Cardiology, 45(2), 39-52. https://doi.org/10.30701/ijc.1708
Section
Clinical Research