Author + information
- Received December 9, 2019
- Revision received May 11, 2020
- Accepted May 11, 2020
- Published online August 12, 2020.
- Wei Hua, MDa,∗,
- Xiaohan Fan, MD, PhDa,∗,
- Xiaofei Li, MDa,
- Hongxia Niu, MDa,
- Min Gu, MDa,
- Xiaohui Ning, MDa,
- Yiran Hu, MDa,
- Michael R. Gold, MD, PhDb and
- Shu Zhang, MD, PhDa,∗ ()
- aState Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- bDivision of Cardiology, Medical University of South Carolina, Charleston, South Carolina
- ↵∗Address for correspondence:
Dr. Shu Zhang, Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, A 167 Bei Li Shi Road, Xicheng District, Beijing 100037, China.
Objective The aim of this study was to assess pacing and electrophysiological parameters, as well as short-term outcomes, among patients undergoing left bundle branch pacing (LBBP) or His bundle pacing (HBP).
Background There are limited data directly comparing different conduction system pacing modalities.
Methods Consecutive patients undergoing de novo conduction system pacing for bradycardia indications were evaluated. Procedural and fluoroscopic times and pacing characteristics were compared between groups at implantation and at 3-month follow-up.
Results This study included 251 subjects. HBP was successful in 109 (87.2%) of 125 patients, compared with 115 (91.3%) of 126 for LBBP. The mean procedure time (78 ± 36 vs. 54 ± 24 minutes, p < 0.001) and fluoroscopy duration (12 ± 5 vs. 5 ± 2.8 minutes, p < 0.001) were significantly longer for HBP compared with LBBP. The paced QRS duration (113.7 ± 24.4 vs. 114.1 ± 11.2 ms) were similar between groups (p = 0.87). Capture threshold was significantly lower (1.3 ± 0.6 V/1.0 ms vs. 0.6 ± 0.2 V/0.4 ms, p < 0.001), whereas R-wave amplitude was significantly higher (2.8 ± 3.0 mV vs. 12.5 ± 9.0 mV, p < 0.001) with LBBP compared with HBP at implantation. During follow-up, a capture threshold >3.0 V occurred in 8 HBP patients versus 0 LBBP patients (p = 0.003).
Conclusions LBBP has similar paced QRS durations and success rates, but shorter procedure and fluoroscopy durations, as well as better pacing parameters compared with HBP. Further prospective study is needed to compare long-term outcomes, safety, and pacing stability with these 2 conduction system pacing modalities.
↵∗ Drs. Wei and Fan contributed equally to this work and are joint first authors.
Dr. Gold is a consultant to Medtronic, Inc. and Boston Scientific. All other authors have reported that they no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received December 9, 2019.
- Revision received May 11, 2020.
- Accepted May 11, 2020.
- 2020 American College of Cardiology Foundation
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