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著者: Vijayaraman P, Subzposh FA, Naperkowski A, Panikkath R, John K, Mascarenhas V, Bauch TD, Huang W.
雑誌名: Heart Rhythm. 2019 Dec;16(12):1774-1782. doi: 10.1016/j.hrthm.2019.05.011. Epub 2019 May 25.
Abstract/Text
BACKGROUND: His bundle pacing (HBP) is the most physiologic form of pacing but associated with higher thresholds and lower success in patients with His-Purkinje conduction disease. Recent reports have described transvenous left bundle branch area pacing (LBBAP).
OBJECTIVE: We aimed to prospectively evaluate the feasibility and the electrophysiologic and echocardiographic characteristics of LBBAP.
METHODS: Patients requiring pacing for bradycardia or heart failure indications (failed left ventricular [LV] lead) were prospectively enrolled. LBBAP was performed with a Medtronic 3830 lead. Presence of left bundle branch (LBB) potential, paced QRS morphology/duration, and peak LV activation time (pLVAT) were recorded at implant. Pacing threshold and sensing was assessed at implant and follow-up. Echocardiography was performed to assess the approximate lead location and impact on tricuspid valve function.
RESULTS: LBBAP was successful in 93 of 100 (93%) patients. Mean age was 75 ± 13 years; men 69%, left bundle branch block 24%, right bundle branch block 25%, intraventricular conduction defect 8%. Indications for pacing were atrioventricular (AV) block 54%, sinus node dysfunction 23%, AV node ablation 7%, cardiac resynchronization therapy 11%, HBP lead failure 7%. Baseline QRS duration was 133 ± 35 ms. Paced QRS duration was 136 ± 17 ms. LBB potentials were observed in 63 patients with left bundle branch - ventricle (LBB-V) interval of 27 ± 6 ms. pLVAT was 75 ± 16 ms. Pacing threshold at implant was 0.6 ± 0.4 V @ 0.5 ms and R waves were 10 ± 6 mV and remained stable at median follow-up of 3 months. The lead depth in the septum was approximately 1.4 ± 0.23 cm.
CONCLUSIONS: LBBAP was feasible in a high percentage of patients with low thresholds during acute follow-up. HBP and LBBAP may significantly increase the overall success of physiologic pacing.
Copyright © 2019 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
PMID 31136869 Heart Rhythm. 2019 Dec;16(12):1774-1782. doi: 10.1016/j.hrthm.2019.05.011. Epub 2019 May 25.
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