AUTHOR=Wei Hui-Qiang , Li Hui , Liao Hongtao , Liang Yuanhong , Zhan Xianzhang , Zhang Qianhuan , Deng Hai , Wei Wei , Liao Zili , Liu Yang , Liu Fangzhou , Lin Weidong , Xue Yumei , Wu Shulin , Fang Xianhong 

TITLE=Feasibility and Safety of Permanent Left Bundle Branch Pacing in Patients With Conduction Disorders Following Prosthetic Cardiac Valves

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.705124

DOI=10.3389/fcvm.2021.705124

ISSN=2297-055X

ABSTRACT=Background The feasibility and safety of left bundle branch pacing (LBBP) in patients with conduction diseases following prosthetic valves (PV) have not been well described.
Methods Permanent LBBP was attempted in patients with PVs. Procedural success and intracardiac electrical measurements were recorded at implant. Pacing threshold, complications and echocardiographic data were assessed at implant and follow-up visit.
Results Twenty-two consecutive patients with atrioventricular (AV) conduction disturbances (10 with AV nodal block and 12 with infranodal block) underwent LBBP. The PVs included aortic valve replacement (AVR) in 6 patients, mitral valve repair or replacement (MVR) with tricuspid valve ring (TVR) in 4 patients, AVR with TVR in 1 patient, AVR with MVR plus TVR in 3 patients, transcatheter aortic valve replacement (TAVR) in 5 patients, and MVR alone in 3 patients. LBBP succeeded in 20 of 22 (90.9%) patients. LBB potential was observed in 15 of 22 (68.2%) patients, including 10 of 15 (66.7%) patients with AVR/TAVR and 5 of 7 (71.4%) patients without AVR/TAVR. AVR and TV ring served as good anatomic landmarks for facilitating the LBBP. The final sites of LBBP were 17.9±1.4mm inferior to the AVR and 23.0±3.2mm distal and septal to the TVR. The paced QRS duration was 124.5±13.8 ms, while the baseline QRS duration was 120.0±32.5 ms (P=0.346). Pacing threshold and R-wave amplitude at implant were 0.60±0.16 V and 11.9±5.5 mV and remained stable at the mean follow-up of 16.1±10.8 months. No significant exacerbation of tricuspid valve regurgitation was observed compared to baseline.
Conclusion
Permanent LBBP could be feasibly and safely obtained in the majority of patients with PVs. The location of the PV might serve as landmarks for guiding the final site of the LBBP. Stable pacing parameters were observed during the follow-up.