Impact on right ventricular performance in patients undergoing permanent
pacemaker implantation: left bundle branch pacing versus right
ventricular septum pacing
Background: The novel method of left bundle branch pacing (LBBP) has
been reported to achieve better electrical and mechanical synchrony in
the left ventricle than conventional right ventricular pacing (RVP).
However, its effects on right ventricle (RV) performance are still
unknown. Methods: Consecutive patients undergoing dual-chamber pacemaker
(PM) implantation for sick sinus syndrome (SSS) with normal cardiac
function and a narrow QRS complex were recruited for the study. The
pacing characteristics and echocardiogram parameters were measured to
evaluate RV function, interventricular and RV synchrony, and were
compared among ventricular pacing‐on and native‐conduction modes.
Results: A total of 84 patients diagnosed with SSS and an indication for
pacing therapy were enrolled. Forty-two patients (50%; mean age 65.50 ±
9.30 years; 35% male) underwent successful LBBP and 42 patients (50%;
mean age 69.26 ± 10.08 years; 33% male) RVSP, respectively. Baseline
characteristics were similar between the two groups. We found no
significant differences in RV function [RV-FAC (Fractional Area
Change)%, 47.13±5.69 vs. 48.60±5.83, p=.069; Endo-GLS (Global
Longitudinal Strain)%, -28.88±4.94 vs. -29.82±5.35, p=.114; Myo-GLS%,
-25.72±4.75 vs. -25.72±5.21, p=.559; Free Wall St%, 27.40±8.03 vs.
-28.71±7.34, p=.304] between the native‐conduction or LBBP capture
modes, while the RVSP capture mode was associated with a significant
reduction in the above parameters compared with the native‐conduction
mode (P < .0001). The interventricular synchrony in the LBBP
group was also superior to the RVSP group significantly. Conclusion:
LBBP is a pacing technique that seems to associate with a positive and
protective impact on RV performance.