ĐÁNH GIÁ BƯỚC ĐẦU HIỆU QUẢ CỦA PHƯƠNG THỨC TẠO NHỊP BÓ NHÁNH TRÁI Ở BỆNH NHÂN CÓ CAN THIỆP VAN TIM

Abstract

Background: Bradyarrhythmias, particularly atrioventricular block and sick sinus syndrome, are among the most common indications for permanent pacemaker implantation. In patients with a history of valve interventions, either surgical or transcatheter, the risk of conduction system injury and postoperative arrhythmias is significantly increased. However, traditional right ventricular pacing has been shown to induce electrical and mechanical dyssynchrony, thereby increasing the risk of pacing-induced cardiomyopathy, especially in patients with a high burden of ventricular pacing. Objective: Evaluation of the feasibility, safety, and efficacy of left bundle branch pacing in patients with prior heart valve intervention. Method: A single-arm interventional study with a pre-post design. Result: From January 2021 to June 2024, a total of 32 patients who underwent left bundle branch pacing (LBBP) following cardiac valve surgery or intervention were enrolled in the study. The mean age was 67.1 ± 14.4 years, with 43.8% being female. Common comorbidities included hypertension (40.6%), diabetes mellitus (21.9%), and dyslipidemia (25%). Heart failure with reduced ejection fraction (HFrEF) was present in 71.9% of patients. Among the cohort, 43.8% had a history of mitral valve replacement, 31.3% underwent transcatheter aortic valve implantation (TAVI), 12.5% had tricuspid valve replacement, and 12.5% had surgical aortic valve replacement (SAVR). Regarding pacing technique, all patients exhibited a notch pattern in lead V1, indicating the potential site for successful LBB capture. The median left ventricular activation time (LVAT) post-procedure was 70 ms [IQR: 60–80 ms]. QRS duration was significantly reduced from 134.4 ± 16.4 ms to 116.9 ± 16.2 ms (p < 0.001). Left ventricular ejection fraction (LVEF) improved from 32.8 ± 3.9% to 39.7 ± 6.3% (p < 0.001). All pacing parameters—including sensing, pacing thresholds, and impedance—remained within normal ranges. The mean procedure time was 85.2 ± 26.4 minutes, with an average fluoroscopy time of 326.7 ± 66.8 seconds. No intra- or post-procedural complications were observed. Conclusion: LBBP demonstrated high feasibility with a 100% success rate, excellent safety with no reported complications, and significant efficacy in improving both electrical synchrony and left ventricular function. This technique represents a promising physiological pacing strategy and may serve as a potential alternative to cardiac resynchronization therapy (CRT) in patients following surgical or transcatheter valve interventions.