Effects of left bundle branch pacing versus right ventricular septal pacing on plasma N-terminal pro-brain natriuretic peptide levels and ventricular remodeling in patients with third-degree atrioventricular block
Objective To compare the effects of left bundle branch pacing and right ventricular septal pacing on plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)levels and ventricular remodeling in patients with third-degree atrioventricular block.Methods A retrospective analysis was conducted on 83 patients with third-degree atrioventricular block who received permanent dual-chamber pacemakers at Xi'an International Medical Center Hospital from January 2021 to December 2023.Participants were allocated into two groups based on the positioning of the ventricular electrode.The control group(n=40)underwent right ventricular septal pacing,while the observation group(n=40)underwent left bundle branch pacing.Pacing parameters were recorded for each group at 7 days and 6 months post-surgery.Comparisons were made between preoperative and postoperative electrocardiogram QRS waves,plasma NT-proBNP levels,and echocardiographic data,including left atrial diameter,left ventricular end-diastolic diameter,left ventricular ejection fraction(LVEF),left atrial volume index(LAVI),tricuspid annular plane systolic excursion(TAPSE),peak velocity of tricuspid regurgitation(TRPV),the ratio of early diastolic peak velocity to late diastolic peak velocity at the mitral annulus,and the ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity(E/Ea).Additionally,the occurrence of complications within 6 months post-surgery was calculated for each group.Results At 6 months post-surgery,the duration of the QRS waves and NT-proBNP levels in the control group were significantly greater than those in the observation group[(131.45±18.40)ms vs.(115.32±17.30)ms,(348.55±48.80)ng/L vs.(318.12±47.72)ng/L,t=4.12,2.87,both P＜0.05].At 6 months post-surgery,the control group exhibited increased LAVI and E/Ea and decreased LVEF and TAPSE,and the LAVI and E/Ea in the control group were significantly higher than those in the observation group(t=2.01,6.23,both P＜0.05).At 6 months post-surgery,LVEF and TAPSE in the control group were significantly lower than those in the control group(t=-2.88,-3.72,both P＜0.05).During the 6-month follow-up,neither group experienced any surgery-related complications.Conclusion Left bundle branch pacing outperforms right ventricular septal pacing in maintaining electrophysiological and mechanical synchronization,providing better preservation of cardiac structure and function,and demonstrating favorable physiological pacing characteristics.
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