Left bundle branch area pacing (LBBAP) is an emerging pacing method that may prevent the deleterious effects of right ventricular pacing. The aim of this study is to compare the effects of LBBAP with right ventricular septal pacing (RVSP) in patients with advanced atrioventricular conduction abnormalities and preserved left ventricular ejection fraction. The effect of pacing was evaluated by echocardiographic indices of dyssynchrony, including global myocardial work efficiency (GWE) and peak systolic dispersion (PSD). The primary endpoint was GWE postprocedural, at 3, 6, and 12 months after the procedure. Twenty patients received LBBAP and 18 RVSP. Complete follow-up was accomplished in 37 patients (97.4%) due to the death of a patient (RVSP arm) from nonrelated cause. GWE was significantly increased in the group of LBBAP compared to RVSP at all time points (90.8% in LBBAP versus 85.8% in RVSP group at 12 months, p = 0.01). PSD was numerically lower in the LBBAP arm at all time points, yet not statistically significant (56.4 msec in LBBP versus 65.1 msec in RVSP arm at 12 months, p = 0.178). The implantation time was increased (median 93 min in LBBAP versus 45 min in RVSP group, p < 0.01), along with fluoroscopy time and dose area product (DAP), in the arm of LBBAP. There were no severe perioperative acute complications in either group. LBBAP is an emerging and safe technique for patients with a pacing indication. Despite the longer procedural and fluoroscopy time, as well as higher DAP, LBBAP seems to offer better left ventricular synchrony compared to RVSP, according to GWE measurements.

中文翻译：

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晚期房室传导异常患者的左束支区域起搏与传统起搏：一项前瞻性队列研究

左束支区起搏（LBBAP）是一种新兴的起搏方法，可以防止右心室起搏的有害影响。本研究的目的是比较 LBBAP 与右心室间隔起搏 (RVSP) 对晚期房室传导异常且左心室射血分数保留的患者的效果。通过超声心动图不同步指数评估起搏效果，包括整体心肌做功效率（GWE）和收缩期峰值离散度（PSD）。主要终点是术后 3、6 和 12 个月的 GWE。20 名患者接受了 LBBAP，18 名患者接受了 RVSP。由于患者（RVSP 组）因非相关原因死亡，37 名患者 (97.4%) 完成了完整随访。与 RVSP 组相比，LBBAP 组在所有时间点的 GWE 均显着增加（12 个月时 LBBAP 组为 90.8%，RVSP 组为 85.8%，p = 0.01）。LBBAP 组在所有时间点的 PSD 在数值上均较低，但不具有统计学意义（12 个月时 LBBP 为 56.4 毫秒，RVSP 组为 65.1 毫秒，p = 0.178）。LBBAP 组的植入时间增加（LBBAP 组中位时间为 93 分钟，而 RVSP 组为 45 分钟，p < 0.01），以及透视时间和剂量面积乘积 (DAP)。两组均未出现严重的围手术期急性并发症。LBBAP 是一种新兴且安全的技术，适用于有起搏指征的患者。根据 GWE 测量，尽管手术和透视时间较长，并且 DAP 较高，但与 RVSP 相比，LBBAP 似乎能提供更好的左心室同步性。