![]() ![]() Its incidence increased over time to more than 50% ( 2). Secondary tricuspid regurgitation was a common comorbidity in patients who had left-sided valve replacement. About 69,000 patients in China underwent valve replacement or repair operations every year ( 1). Left-sided valve surgery was a common procedure for left heart valve (mitral valve, and aortic valve) disease. In multivariate liner regression analysis, the pacing ratio ( β = 0.736, P = 0.037) was an independent determinant of tricuspid regurgitation velocity variation.Ĭonclusion: HPSP might reduce tricuspid regurgitation and improve cardiac function in patients with persistent atrial fibrillation after left-sided valve surgery. The NYHA classification of patients also improved ( P = 0.013). The cardiothoracic ratio of patients was significantly lower than that before implantation (0.61 ± 0.08 vs. The tricuspid regurgitation velocity significantly decreased (317 ± 74 cm/s vs. At 3-month follow-up, the tricuspid regurgitation grade was significantly lower than that before implantation ( P = 0.007). Three of them received HBP and five underwent LBBP. All patients had persistent atrial fibrillation. Eight patients who had undergone implantation of HPSP after left-sided heart valve replacement were enrolled in the study. Results: A total of 44 patients was retrospectively reviewed. Univariate and multivariate linear regression analysis of tricuspid regurgitation velocity were performed. Clinical data collected included electrocardiogram, pacing parameters, ultrasonic cardiogram parameters and chest x-ray at implantation and 3-month follow up. HPSP included His bundle pacing (HBP) or left bundle branch pacing (LBBP). The 3-year patient review focused on those who underwent permanent cardiac pacemaker implantation of HPSP after mitral valve and/or aortic valve replacement from Jan 1st, 2019 to Jan 1st, 2022. Methods: This study was a retrospective study. Our study aimed to investigate the effect of HPSP on tricuspid regurgitation in patients with persistent atrial fibrillation after left-sided valve surgery. His-Purkinje system pacing (HPSP) was a physiological pacing method, which could prevent and treat heart failure and might reduce tricuspid regurgitation. Atrial fibrillation was considered to be an important etiology of tricuspid regurgitation. 2Department of Ultrasound, Peking University International Hospital, Beijing, Chinaīackground & objective: Tricuspid regurgitation after left-sided valve surgery was a common and difficult problem.1Department of Cardiology, Peking University International Hospital, Beijing, China.CONCLUSIONS This report of a case of AF associated with LBBB shows that pharmacologic CRT can restore sinus rhythm following catheter ablation and can reduce heart rate and treat heart failure without the use of an ICD.Ning Wang 1,†, Tianyu Zhu 1,†, Yan Li 1, Guanliang Cheng 1, Yu Chen 1, Yuwei Fu 2, Xuezhi Chen 1* and Xiaohui Liu 1 The patient was treated with step-wise decreasing doses of amiodarone, from 200 mg to 75 mg daily, and step-wise increasing doses of bisoprolol, from 3.75 mg to 5.0 mg daily, which effectively slowed heart rate, inhibited aberrant cardiac conduction due to LBBB, reduced the symptoms of heart failure, and improved LVEF to 60%, despite persistent sinus bradycardia and the inability of the heart rate to increase during activity (chronotropic incompetence). Catheter ablation for AF resulted in the restoration of sinus rhythm. Echocardiography showed a left ventricular ejection fraction (LVEF) of 30%. Serial electrocardiograms (ECGs) showed AF and mixed narrow (116 ms) and wide (152 ms) QRS duration of LBBB. CASE REPORT A 68-year-old man presented with persistent AF and systolic heart failure. This report is a case of LBBB treated with pharmacologic CRT, without the use of an ICD. However, in some patients, LBBB may vary with heart rate, and during episodes of AF in LBBB, aberrant ventricular conduction, or wide QRS complex tachycardia (Ashman beats) can occur. BACKGROUND Left bundle branch block (LBBB) is associated with atrial fibrillation (AF) and systolic heart failure, which can be treated with cardiac resynchronization therapy (CRT) that includes an implantable cardiac device (ICD). ![]()
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