Results
Ninety procedures were performed in 87 patients (median age 76 years;
61.1% male): 46 (51.1%) underwent HBP and 44 (48.9%) underwent LBBAP.
One patient underwent two HBP implantations and two patients underwent
LBBAP after an initial HBP procedure due to lead-related complications.
Table 1 exhibits the baseline characteristics of the patients. There
were no significant differences between HBP and LBBAP groups in
hypertension (HT) (P < .01), structural heart disease
(P < .05), or sinus atrial rhythm (P = .05). All
patients with wide baseline QRS (n= 49) had a QRS duration of ≥ 130 ms.
Left bundle branch potential was recorded in 7 (15.9%) of LBBAP
procedures.
A successful outcome was obtained in 85% (77/90) of the implantations,
80.4% (n = 37) in the HBP group and 90.9% (n = 40) in the LBBAP group
(P = .23). Among the thirteen failures, four were in the LBBAP
group and nine in the HBP group. The interventricular septum could not
be penetrated in all patients in the LBBAP group. In the HBP group, the
His electrogram was not recorded in five, there was no QRS reduction in
two indicated for CRT, the paced QRS width was > 130 ms
(baseline < 120 ms) in one, and effective capture was not
achieved in the other. Conventional CRT was performed in seven cases of
failure and also in six cases of anti-bradycardia pacing, with the lead
being placed in the right ventricle outflow tract in five and kept in
the HBP zone in one (QRS 136 ms). The fluoroscopy time was shorter for
LBBAP than for HBP (10 vs. 17 min, P < .001).
In the univariate analysis, a successful outcome was related to age,
sex, baseline QRS width, baseline LVEF, and presence of a previous
device; none was retained as an independent predictor, but the presence
of a previous device was associated with a lower success rate (odds
ratio (OR) 5.9; 95% confidence interval (CI) 0.85–42.2;P = .072).
Similar complication rates were recorded at the three-month follow-up
(including complications before hospital discharge) between the HBP
group (12.8%, n = 6) and the LBBAP group (6.8%, n = 3)
(P = .48). There were three non-lead-related complications, one
in the HBP group (pocket infection) and two in the LBBAP group (subacute
pericardial effusion and hematoma). Lead-related complications were more
frequent in the HBP group (10.6% vs. 2.3%; P = .2), with two
losses of capture, one displacement, and two significant increases in
pacing threshold; there was only one displacement in the LBBAP group (in
a patient who had already suffered HBP displacement).