# Left Bundle Branch Area Pacing Contributes to a Greater Acute Blood Pressure Reduction Compared to Right Ventricular Pacing

## TL;DR

This study found that left bundle branch area pacing leads to a greater immediate drop in blood pressure compared to right ventricular pacing in patients with bradycardia.

## Contribution

The novel finding is that LBBAP causes a more significant acute systolic blood pressure reduction than RVP, which was previously unexplored.

## Key findings

- LBBAP resulted in a greater systolic blood pressure reduction compared to RVP (Δ11.6 mmHg vs. Δ7.6 mmHg).
- Patients with high baseline blood pressure and those not using anti-hypertensive drugs showed a larger SBP reduction with LBBAP.
- Systolic blood pressure decreased significantly from baseline to the acute period after pacemaker implantation.

## Abstract

Several previous studies have explored the potential
arterial blood pressure (BP) changes in patients undergoing right ventricular
pacing (RVP), however, the relationship between left bundle branch area pacing
(LBBAP) and BP variations remains unknown. This study aimed to examine the acute
BP variations following LBBAP and RVP implantation in patients with bradycardia.

We conducted a single-center retrospective study including all
patients who underwent de-novo dual-chamber pacemaker implantation between
January 2019 and June 2021. Patients were divided into two groups, LBBAP and RVP,
and propensity score-matching (PSM) was used to balance confounding factors.
Three time periods were defined according to the timing of the implant: baseline
(within 24 hours before implantation), hyper-acute period (0–24 hours
post-implantation), and acute period (24–48 hours post-implantation). BP was
measured at least three times per period using an arm pressure cuff and then
averaged for analysis, which allowed us to determine the acute impact of
pacemaker implantation on BP.

From a cohort of 898 patients,
193 LBBAP receivers were matched to 193 RVP receivers. A significant decrease in
systolic BP (SBP) after the implantation was observed in the study cohort, from
baseline 137.3 ± 9.2 mmHg to the acute period of 127.7 ± 9.4 mmHg
(p < 0.001). The LBBAP group exhibited a greater SBP reduction than
the RVP group (Δ11.6 ± 6.2 mmHg vs. Δ7.6 ± 5.8
mmHg, p
< 0.001). In further subgroup analysis, LBBAP receivers who
had high baseline SBP (p
< 0.001) and those without using
anti-hypertensive drugs (p = 0.045) appeared to have a higher magnitude
of SBP reduction.

Permanent pacemaker implantation may
contribute to an acute decrease in systolic BP, which was more pronounced in
LBBAP receivers. Future experimental and clinical investigations are necessary to
explore the underlying mechanisms and the long-term hemodynamic effects of LBBAP
versus RVP.