AIMS: Permanent transseptal left bundle branch area pacing (LBBAP) is a promising new pacing method for both bradyarrhythmia and heart failure indications. However, data regarding safety, feasibility and capture type are limited to relatively small, usually single centre studies. In this large multicentre international collaboration, outcomes of LBBAP were evaluated. METHODS AND RESULTS: This is a registry-based observational study that included patients in whom LBBAP device implantation was attempted at 14 European centres, for any indication. The study comprised 2533 patients (mean age 73.9 years, female 57.6%, heart failure 27.5%). LBBAP lead implantation success rate for bradyarrhythmia and heart failure indications was 92.4% and 82.2%, respectively. The learning curve was steepest for the initial 110 cases and plateaued after 250 cases. Independent predictors of LBBAP lead implantation failure were heart failure, broad baseline QRS and left ventricular end-diastolic diameter. The predominant LBBAP capture type was left bundle fascicular capture (69.5%), followed by left ventricular septal capture (21.5%) and proximal left bundle branch capture (9%). Capture threshold (0.77 V) and sensing (10.6 mV) were stable during mean follow-up of 6.4 months. The complication rate was 11.7%. Complications specific to the ventricular transseptal route of the pacing lead occurred in 209 patients (8.3%). CONCLUSIONS: LBBAP is feasible as a primary pacing technique for both bradyarrhythmia and heart failure indications. Success rate in heart failure patients and safety need to be improved. For wider use of LBBAP, randomized trials are necessary to assess clinical outcomes.

• MeSH
• blokáda Tawarova raménka terapie   etiologie   MeSH
• bradykardie terapie   etiologie   MeSH
• elektrokardiografie metody   MeSH
• Hisův svazek * MeSH
• kardiostimulace umělá škodlivé účinky   metody   MeSH
• lidé MeSH
• senioři MeSH
• srdeční selhání * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH

Souhrn: Stimulace oblasti levého Tawarova raménka (LBBAP) je nový způsob stimulace u nemocných s bradykardií či indikací k resynchronizační terapii (CRT). Údajů o peroperačních a pooperačních výsledcích této metody je nedostatek. Metody: Do registru byli zařazeni všichni nemocní s bradykardií nebo indikací k CRT, u kterých byla v období 11/2018-5/2021 v průběhu operačního zákroku prováděna LBBAP v Kardiocentru FNKV a 3. LF UK. Většina pacientů byla do registru zařazena prospektivně a vybrané ukazatele byly doplňovány retrospektivně. Ke shromáždění základních klinických, peroperačních a pooperačních ukazatelů byly použity údaje z elektronického nemocničního infomačního systému a elektrofyziologického zařízení používaného v průběhu operačních zákroků. Výsledky: LBBAP byla prováděna u 329 pacientů, z toho se jednalo o 237 nemocných s bradykardií a 92 nemocných se CRT indikací. Stimulační prahy k dosažení LBBAP byly průměrně 0,6 ± 0,5V na 0,5 ms a při průměrné délce sledování 5 ± 5 měsíců byly stabilní (0,7 ± 0,3V na 0,4 ms). Komplikace byly pozorovány u 26 pacientů (8 %), z toho se u 15 z nich jednalo o komplikace specifické pro LBBAP (12× peroperační penetrace elektrody do dutiny LKS, 1× bolest na hrudi a 1× bolest na hrudi s elevacemi ST úseků po fixaci elektrody), které však odezněly bez následků ještě v průběhu zákroku. Celková úspěšnost LBBAP byla 89 % a byla signifikantně vyšší u pacientů s bradykardií, než u pacientů se CRT indikací (92 % vs. 83 %, p = 0,02). Byl pozorován významný vliv počtu provedených zákroků na úspěšnost LBBAP a výskyt některých komplikací. Závěr: LBBAP je možnou alternativou trvalé kardiostimulace u pacientů s bradykardií a indikací k CRT. Vyskytují se u ní některé specifické komplikace, jejichž význam je potřeba posoudit v kontextu benefitu metody v randomizovaných studiích.

Summary: Left bundle branch area pacing (LBBAP) is a new method of pacing in patients who have bradycardia or are indicated to receive cardiac resynchronization therapy (CRT). Data on intraoperative and postoperative outcomes of this method are lacking. Methods: All patients with bradycardia or an indication for CRT, who underwent LBBAP during a surgical procedure at the Heart Centre of the Kralovske Vinohrady University Hospital and the Third Faculty of Medicine of Charles University in the period from 11/2018 to 05/2021, were included in the registry. Most patients were included in the registry in a prospective manner, and selected parameters were added retrospectively. To obtain basic clinical, intraoperative, and postoperative parameters, data from the electronic hospital information system and the electrophysiological device employed during the course of surgical procedures were used. Results: LBBAP was performed in 329 patients, of which 237 had bradycardia and 92 were indicated to receive CRT. The pacing thresholds for achieving LBBAP were 0.6 ± 0.5 V per 0.5 ms on average, and were stable with a mean follow-up duration of 5 ± 5 months (0.7 ± 0.3 V per 0.4 ms). Complications were seen in 26 patients (8%), of which 15 were specific complications related to LBBAP (12 cases of intraoperative lead penetration into the right ventricle, 1 case of chest pain, and 1 case of chest pain with ST segment elevation after lead placement) which, however, resolved without sequelae during the course of the procedure. The overall success rate of LBBAP was 89% and was significantly higher in patients with bradycardia than in those indicated to receive CRT (92% vs 83%, p = 0.02). A significant effect of the number of procedures performed on the success rate of LBBAP and the rate of some complications was observed. Conclusion: LBBAP is a possible alternative to permanent cardiac pacing in patients who have bradycardia or are indicated to receive CRT. It is associated with certain specific complications, whose significance requires evaluation in terms of the method's benefit in randomized trials.

• MeSH
• bradykardie terapie   MeSH
• Hisův svazek * MeSH
• implantované elektrody MeSH
• lidé MeSH
• pooperační komplikace MeSH
• registrace MeSH
• retrospektivní studie MeSH
• srdeční resynchronizační terapie * metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• srovnávací studie MeSH

BACKGROUND: Left bundle branch area pacing (LBBAP) is an emerging technique to achieve cardiac resynchronization therapy (CRT), but its feasibility and safety in elderly patients with heart failure with reduced ejection fraction and left bundle branch block is hardly investigated. METHODS: We enrolled consecutive patients with an indication for CRT comparing pacing parameters and complication rates of LBBAP-CRT in elderly patients (≥ 75 years) versus younger patients (< 75 years) over a 6-month follow-up. RESULTS: LBBAP was successful in 55/60 enrolled patients (92%), among which 25(45%) were elderly. In both groups, LBBAP significantly reduced the QRS duration (elderly group: 168 ± 15 ms to 136 ± 12 ms, p < 0.0001; younger group: 166 ± 14 ms to 134 ± 11 ms, p < 0.0001) and improved LVEF (elderly group: 28 ± 5% to 40 ± 7%, p < 0.0001; younger group: 29 ± 5% to 41 ± 8%, p < 0.0001). The pacing threshold was 0.9 ± 0.8 V in the elderly group vs. 0.7 ± 0.5 V in the younger group (p = 0.350). The R wave was 9.5 ± 3.9 mV in elderly patients vs. 10.7 ± 2.7 mV in younger patients (p = 0.341). The fluoroscopic (elderly: 13 ± 7 min vs. younger: 11 ± 7 min, p = 0.153) and procedural time (elderly: 80 ± 20 min vs. younger: 78 ± 16 min, p = 0.749) were comparable between groups. Lead dislodgement occurred in 2(4%) patients, 1 in each group (p = 1.000). Intraprocedural septal perforation occurred in three patients (5%), 2(8%) in the elderly group (p = 0.585). One patient (2%) in the elderly group had a pocket infection. CONCLUSIONS: LBBAP is a feasible and safe technique for delivering physiological pacing in elderly patients who are candidates for CRT with suitable pacing parameters and low complication rates.

• MeSH
• elektrokardiografie metody   MeSH
• Hisův svazek MeSH
• kardiostimulace umělá škodlivé účinky   metody   MeSH
• lidé MeSH
• senioři MeSH
• srdeční resynchronizační terapie * metody   MeSH
• studie proveditelnosti MeSH
• tepový objem MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• elektrokardiografie MeSH
• funkce levé komory srdeční MeSH
• Hisův svazek MeSH
• kardiostimulace umělá MeSH
• lidé MeSH
• převodní systém srdeční * MeSH
• srdeční komory diagnostické zobrazování   MeSH
• srdeční resynchronizační terapie * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) is effective in patients with heart failure, left bundle branch block (LBBB), and reduced left ventricular function. Left bundle branch area pacing (LBBAP) has been reported as an alternative option for CRT. OBJECTIVE: The purpose of this study was to assess the feasibility and outcomes of LBBAP in patients who failed conventional BVP because of coronary venous (CV) lead complications or who were nonresponders to BVP. METHODS: At 16 international centers, LBBAP was attempted in patients with conventional CRT indication who failed BVP because of CV lead complications or lack of therapeutic response to BVP. Heart failure hospitalization (HFH) and death, echocardiographic outcomes, procedural data, pacing parameters, and lead complications including CV lead failure are reported. RESULTS: LBBAP was successfully performed in 200 patients (CV lead failures 156; nonresponders 44) (age 68 ± 11 years; female 35%; LBBB 55%; right ventricular pacing 23%; ischemic cardiomyopathy 28%; nonischemic cardiomyopathy 63%; left ventricular ejection fraction [LVEF] ≤35% in 80%). Procedural duration was 119.5 ± 59.6 minutes, and fluoroscopy duration was 25.7 ± 18.5 minutes. LBBAP threshold and R-wave amplitudes were 0.68 ± 0.35 V @ 0.45 ms and 10.4 ± 5 mV at implant, respectively, and remained stable during mean follow-up of 12 ± 10.1 months. LBBAP resulted in significant QRS narrowing from 170 ± 28 ms to 139 ± 25 ms (P <.001) with V6 R-wave peak times of 85 ± 17 ms. LVEF improved from 29% ± 10% at baseline to 40% ± 12% (P <.001) during follow-up. The risk of death or HFH was lower in those with CV lead failure than in nonresponders (hazard ratio 0.357; 95% confidence interval 0.168-0.756; P = .007) CONCLUSION: LBBAP is a viable alternative to CRT in patients who failed conventional BVP due to CV lead failure or who were nonresponders.

• MeSH
• blokáda Tawarova raménka diagnóza   etiologie   terapie   MeSH
• elektrokardiografie metody   MeSH
• funkce levé komory srdeční fyziologie   MeSH
• Hisův svazek MeSH
• kardiostimulace umělá metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• srdeční arytmie terapie   MeSH
• srdeční resynchronizační terapie * metody   MeSH
• srdeční selhání * diagnóza   etiologie   terapie   MeSH
• tepový objem MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Adoption and outcomes for conduction system pacing (CSP), which includes His bundle pacing (HBP) or left bundle branch area pacing (LBBAP), in real-world settings are incompletely understood. We sought to describe real-world adoption of CSP lead implantation and subsequent outcomes. METHODS: We performed an online cross-sectional survey on the implantation and outcomes associated with CSP, between November 15, 2020, and February 15, 2021. We described survey responses and reported HBP and LBBAP outcomes for bradycardia pacing and cardiac resynchronization CRT indications, separately. RESULTS: The analysis cohort included 140 institutions, located on 5 continents, who contributed data to the worldwide survey on CSP. Of these, 127 institutions (90.7%) reported experience implanting CSP leads. CSP and overall device implantation volumes were reported by 84 institutions. In 2019, the median proportion of device implants with CSP, HBP, and/or LBBAP leads attempted were 4.4% (interquartile range [IQR], 1.9-12.5%; range, 0.4-100%), 3.3% (IQR, 1.3-7.1%; range, 0.2-87.0%), and 2.5% (IQR, 0.5-24.0%; range, 0.1-55.6%), respectively. For bradycardia pacing indications, HBP leads, as compared to LBBAP leads, had higher reported implant threshold (median [IQR]: 1.5 V [1.3-2.0 V] vs 0.8 V [0.6-1.0 V], p = 0.0008) and lower ventricular sensing (median [IQR]: 4.0 mV [3.0-5.0 mV] vs. 10.0 mV [7.0-12.0 mV], p < 0.0001). CONCLUSION: In conclusion, CSP lead implantation has been broadly adopted but has yet to become the default approach at most surveyed institutions. As the indications and data for CSP continue to evolve, strategies to educate and promote CSP lead implantation at institutions without CSP lead implantation experience would be necessary.

• MeSH
• bradykardie * terapie   MeSH
• elektrokardiografie MeSH
• Hisův svazek * MeSH
• kardiostimulace umělá MeSH
• lidé MeSH
• nemoci převodního systému srdečního MeSH
• převodní systém srdeční MeSH
• průřezové studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The clinical impact of Periprocedural myocardial injury (PMI) in patients undergoing permanent pacemaker implantation with Left Bundle Branch Area Pacing (LBBAP) is unknown. METHODS: 130 patients undergoing LBBAP from January 2020 to June 2021 and completing 12 months follow up were enrolled to assess the impact of PMI on composite clinical outcome (CCO) defined as any of the following: all-cause death, hospitalization for heart failure (HHF), hospitalization for acute coronary syndrome (ACS) and ventricular arrhythmias (VAs). High sensitivity Troponin T (HsTnT) was measured up to 24-h after intervention to identify the peak HsTnT values. PMI was defined as increased peak HsTnT values at least > 99th percentile of the upper reference limit (URL: 15 pg/ml) in patients with normal baseline values. RESULTS: PMI occurred in 72 of 130 patients (55%). ROC analysis yielded a post-procedural peak HsTnT cutoff of fourfold the URL for predicting the CCO (AUC: 0.692; p = 0.023; sensitivity 73% and specificity 71%). Of the enrolled patients, 20% (n = 26) had peak HsTnT > fourfold the URL. Patients with peak HsTnT > fourfold the URL exhibited a higher incidence of the CCO than patients with peak HsTnT ≤ fourfold the URL (31% vs. 10%; p = 0.005), driven by more frequent hospitalizations for ACS (15% vs. 3%; p = 0.010). Multiple (> 2) lead repositions attempts, the use of septography and stylet-driven leads were independent predictors of higher risk of PMI with peak HsTnT > fourfold the URL. CONCLUSIONS: PMI seems common among patients undergoing LBBAP and may be associated with an increased risk of clinical outcomes in case of more pronounced (peak HsTnT > fourfold the URL) myocardial damage occurring during the procedure.

• MeSH
• blokáda Tawarova raménka MeSH
• kardiostimulace umělá MeSH
• lidé středního věku MeSH
• lidé MeSH
• poranění srdce etiologie   MeSH
• senioři MeSH
• troponin T * krev   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Left bundle branch area pacing (LBBAP) comprises pacing at the left ventricular septum (LVSP) or left bundle branch (LBBP). The aim of the present study was to investigate the differences in ventricular electrical heterogeneity between LVSP, LBBP, right ventricular pacing (RVP) and intrinsic conduction with different dyssynchrony measures using the ECG, vectorcardiograpy, ECG belt, and Ultrahigh frequency (UHF-)ECG. METHODS: Thirty-seven patients with a pacemaker indication for bradycardia or cardiac resynchronization therapy underwent LBBAP implantation. ECG, vectorcardiogram, ECG belt and UHF-ECG signals were recorded during RVP, LVSP and LBBP, and intrinsic activation. QRS duration (QRSd) was measured from the ECG, QRS area was calculated from the vectorcardiogram, LV activation time (LVAT) and standard deviation of activation time (SDAT) from ECG belt and electrical dyssynchrony (e-DYS16) from UHF-ECG. RESULTS: Both LVSP and LBBP significantly reduced ventricular electrical heterogeneity as compared to underlying LBBB and RV pacing in terms of QRS area (p < .001), SDAT (p < .001), LVAT (p < .001) and e-DYS16 (p < .001). QRSd was only reduced as compared to RV pacing(p < .001). QRS area was similar during LBBP and normal intrinsic conduction, e-DYS16 was similar during LVSP and normal intrinsic conduction, whereas SDAT was similar for LVSP, LBBP and normal intrinsic conduction. For all these variables there was no significant difference between LVSP and LBBP. CONCLUSION: Both LVSP and LBBP resulted in a more synchronous LV activation than LBBB and RVP. Especially LBBP resulted in levels of LV synchrony comparable to normal intrinsic conduction.

• MeSH
• akční potenciály * MeSH
• blokáda Tawarova raménka patofyziologie   terapie   diagnóza   MeSH
• bradykardie patofyziologie   terapie   diagnóza   MeSH
• časové faktory MeSH
• elektrofyziologické techniky kardiologické MeSH
• elektrokardiografie MeSH
• funkce levé komory srdeční * MeSH
• Hisův svazek * patofyziologie   MeSH
• kardiostimulace umělá * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mezikomorová přepážka * patofyziologie   MeSH
• prediktivní hodnota testů * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční frekvence * MeSH
• srdeční resynchronizační terapie MeSH
• vektorkardiografie * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

BACKGROUND: During left bundle branch (LBB) area pacing, it is important to confirm that capture of the LBB, and not just capture of only adjacent left ventricular (LV) myocardium, has been achieved. OBJECTIVE: The purpose of this study was to establish electrocardiographic (ECG) criteria for LBB capture. We hypothesized that because LBB pacing results in physiological depolarization of the LV, then the native QRS can serve as a reference for diagnosis of LBB capture in the same patient. METHODS: Only patients with evidence of LBB capture (QRS morphology transition) were included. Several QRS characteristics were compared between the native rhythm and different types of LBB area capture. RESULTS: A total of 357 ECGs (124 patients) were analyzed: 118 with native rhythm, 124 with nonselective LBB capture, 69 with selective LBB capture, and 46 with LV septal capture. Our hypotheses that during LBB capture the paced V6 R-wave peak time (RWPT; measured from QRS onset) equals the native V6 RWPT and that the paced V6 RWPT (measured from the stimulus) equals the LBB potential to V6 R-wave peak interval were positively validated. Criteria based on these rules had sensitivity and specificity of 88.2%-98.0% and 85.7%-95.4%, respectively. Moreover, 100% specific V6 RWPT cutoff for LBB capture diagnosis in patients with narrow QRS/right bundle branch block was determined to be 74 ms. CONCLUSION: We showed equivalency of LV activation times on ECG during native and paced LBB conduction. Therefore, if V6 RWPT is longer during pacing, this finding is indicative of lack of LBB capture.

• MeSH
• blokáda Tawarova raménka patofyziologie   terapie   MeSH
• elektrokardiografie metody   MeSH
• Hisův svazek fyziologie   MeSH
• kardiostimulace umělá metody   MeSH
• lidé MeSH
• převodní systém srdeční patofyziologie   MeSH
• senioři MeSH
• srdeční frekvence fyziologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH

Biventricular pacing (Biv) and left bundle branch area pacing (LBBAP) are methods of cardiac resynchronization therapy (CRT). Currently, little is known about how they differ in terms of ventricular activation. This study compared ventricular activation patterns in left bundle branch block (LBBB) heart failure patients using an ultra-high-frequency electrocardiography (UHF-ECG). This was a retrospective analysis including 80 CRT patients from two centres. UHF-ECG data were obtained during LBBB, LBBAP, and Biv. Left bundle branch area pacing patients were divided into non-selective left bundle branch pacing (NSLBBP) or left ventricular septal pacing (LVSP) and into groups with V6 R-wave peak times (V6RWPT) < 90 ms and ≥ 90 ms. Calculated parameters were: e-DYS (time difference between the first and last activation in V1-V8 leads) and Vdmean (average of V1-V8 local depolarization durations). In LBBB patients (n = 80) indicated for CRT, spontaneous rhythms were compared with Biv (39) and LBBAP rhythms (64). Although both Biv and LBBAP significantly reduced QRS duration (QRSd) compared with LBBB (from 172 to 148 and 152 ms, respectively, both P < 0.001), the difference between them was not significant (P = 0.2). Left bundle branch area pacing led to shorter e-DYS (24 ms) than Biv (33 ms; P = 0.008) and shorter Vdmean (53 vs. 59 ms; P = 0.003). No differences in QRSd, e-DYS, or Vdmean were found between NSLBBP, LVSP, and LBBAP with paced V6RWPTs < 90 and ≥ 90 ms. Both Biv CRT and LBBAP significantly reduce ventricular dyssynchrony in CRT patients with LBBB. Left bundle branch area pacing is associated with more physiological ventricular activation.

• Publikační typ
• časopisecké články MeSH