| Background:Studies have shown that atrial high rate episodes are associated with increased stroke risk and predisposition to clinical atrial fibrillation with a higher stroke risk.There is currently a lack of data comparing the incidence of postoperative atrial high rate episodes between left bundle branch area pacing and conventional right ventricular pacing in patients with successful dual-chamber pacemaker implantation.Objective:To investigate the differences in the incidence of atrial high rate episodes between the two groups in patients who have undergone left bundle branch area pacing and conventional right ventricular pacing.Methods:Patients who successfully underwent dual-chamber pacemaker implantation in the Second Affiliated Hospital of Nanchang University from January 2018 to December 2020 were screened and divided into left bundle branch area pacing group and right ventricular traditional pacing group according to the pacing technique.The pacemaker programming data of the two groups at 3 months,6 months,1 year,and 2years after surgery were retrospectively analyzed,and the incidence of atrial high rate episodes at 2 years after surgery was compared between the two groups;subgroups were divided according to the percentage of ventricular pacing.The differences in the incidence of atrial high rate episodes between the two types of pacing procedures were compared between each subgroup;at the same time,multivariate COX risk regression analysis was performed to screen out the risk factors that increase the risk of AHRE.Results:In the end,104 subjects were included in each of the two groups.Compared with the right ventricular pacing group,the age of the left bundle branch area pacing group(66.07 ± 10.89 vs 70.28 ± 9.37,P=0.02),coronary heart disease [7(6.7%)vs.20(19.2%),P=0.012],preoperative LVEF value [(58.0 ± 13.1)% vs(63.2 ± 6.3)%,P=0.022] and CHA2DS2-VASc score [(2.6±1.6)vs(3.2)±2.1),P = 0.0035] was lower,while preoperative QRS duration [(124.5 ± 41.9)ms vs(104.1 ± 23.1)ms,P < 0.01] and operative time [(127.8 ± 33.8)min vs(101.4 ± 29.4))min,P <0.01] higher.There were no differences in baseline data such as gender,hypertension,diabetes,heart failure and NYHA classification between the two groups(P>0.05).The incidence of atrial high rate episodes in the left bundle branch pacing group was significantly lower than that in the right ventricular pacing group [16(15.4%)vs 31(29.8%),P=0.013];The AHRE-free survival rate in the pacing group was lower than that in the left bundle branch pacing group(HR: 2.026;95%CI: 1.108-3.704,P=0.022).After adjusting for confounding factors such as coronary heart disease and CHA2DS2-VASc score,the right ventricular pacing group The survival rate was also lower(HR: 1.741;95% CI: 1.014-3.246,P=0.046),indicating that RV pacing was an independent risk factor for AHRE.The results of subgroup analysis according to the percentage of ventricular pacing showed that when the percentage of ventricular pacing was ≥20%(HR: 2.321;95% CI: 1.171-4.60,P=0.016),≥40%(HR: 2.323;95%)CI: 1.172-4.605,P=0.016),≥60%(HR: 2.237;95%CI: 1.113-4.496,P=0.024)and ≥ 80%(HR: 1.918;95%CI: 1.031-3.951,P= 0.046),compared with the left bundle branch area pacing group,right ventricular pacing had a higher risk of AHRE;when the percentage of ventricular pacing was less than 20%,there was no statistical difference between the two groups(P > 0.05).Conclusion:The incidence of AHRE after LBBAP was lower than that of RVP,and a high percentage of VP(≥20%)was the main driver of the difference in outcomes.RVP is one of the risk factors that increases the risk of AHRE.For patients with indications for dual-chamber pacemaker implantation,when a high VP percentage is required,left bundle branch area pacing may be a better choice,and large randomized controlled trials are needed for further validation in the future. |
PDF Full Text Request