Left Bundle Branch Pacing Versus Right Ventricular Pacing in Patients With Atrioventricular Block

Study Overview
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Brief Summary
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Although emerging evidence demonstrated that left bundle branch pacing (LBBP) is a promising alternative for patients with either a bradycardia or a heart failure pacing indication. However, a direct comparison of the safety, efficacy and LV systolic synchrony between LBBP and RVP regimens was rare. In this study, the investigators aim to conduct a comparison of the safety and effectiveness performance between these two pacing methods for patients with atrioventricular block (AVB). The investigators focused on AVB patients undergoing permanent pacemaker implantations from the 1st of January 2018 to the 18th of November 2021 at West China Hospital.

Detailed Description
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Right ventricular pacing (RVP) is the standard treatment for patients with continuous ventricular pacing needs. However, clinical studies have shown that RVP can cause electrical and mechanical dyssynchrony of the left ventricle and increase the risks of cardiac insufficiency, atrial fibrillation (AF) and death. Although emerging evidence demonstrated that left bundle branch pacing (LBBP) is a promising alternative for patients with either a bradycardia or a heart failure pacing indication. However, a direct comparison of the safety, efficacy and LV systolic synchrony between LBBP and RVP regimens was rare. In this study, the investigators aim to conduct a comparison of the safety and effectiveness performance between these two pacing methods for patients with atrioventricular block (AVB). The investigators focused on AVB patients undergoing permanent pacemaker implantations from the 1st of January 2018 to the 18th of November 2021 at West China Hospital.

Official Title
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Left Bundle Branch Pacing Versus Right Ventricular Pacing in Patients With Atrioventricular Block: an Observational Cohort Study

Conditions
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AVB - Atrioventricular Block

Intervention / Treatment
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* Procedure: left bundle branch pacing (LBBP)
* Procedure: Right ventricular pacing (RVP)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: included consecutively high-grade AVB patients undergoing permanent pacemaker implantations from the 1 s t of January 2018 to the 18 thof November 2021 at West China Hospital Exclusion Criteria: patients with pacemaker replacements were excluded.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| high-grade AVB patients undergoing permanent pacemaker implantations<br> | Procedure: left bundle branch pacing (LBBP)<br>* After recording the His potential, the 3830-69 lead (Medtronic Inc., Minneapolis, MN USA) was sent 1-2 cm forward and downward to find the insertion point of the right side of intra-ventricular septum combined with the pre-rotation impedance and ECG changes. Ultimately, the tip was perpendicularly straightforward posited against the septum to the left septal side .<br>Procedure: Right ventricular pacing (RVP)<br>* Right ventricular pacing (RVP) is the standard treatment for patients with continuous ventricular pacing needs.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| composed of all-cause mortality, lead failure and heart failure hospitalization (HFH) during the follow-ups | composed of all-cause mortality, lead failure and heart failure hospitalization (HFH) during the follow-ups | through study completion, an average of 2.45 year | 
| Lead failure | reintervention for increased pacing thresholds, lead dislocation or ventricular perforation after the initial implantation procedure | through study completion, an average of 2.45 year | 
| HFH | HFH was defined as the admission to hospital for >24 hours with worsening symptoms and signs of heart failure and requiring one or more intravenous diuretics or intravenous inotropic medications | through study completion, an average of 2.45 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| peri-procedure complication | included pericardial tamponade and pneumothorax | through study completion, an average of 2.45 year | 
| cardiac death | documented arrhythmogenic death, an unexpected presumed pulseles condition with the absence of an obvious noncardiac explanation, or a death due to congestive cardiac failure or structural heart disease | through study completion, an average of 2.45 year | 
| recurrent unexplained syncope | recurrent unexplained syncope | through study completion, an average of 2.45 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Left bundle branch pacing, Right ventricular pacing, Mortality, Systolic dyssynchrony