Comparison of Left Bundle-Branch Area Pacing to Biventricular Pacing in Candidates for Resynchronization Therapy
Abstrakt
BACKGROUND: Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is a well-established therapy in patients with reduced left ventricular ejection fraction (LVEF), heart failure, and wide QRS or expected frequent ventricular pacing. Left bundle branch area pacing (LBBAP) has recently been shown to be a safe alternative to BVP.
OBJECTIVE: The aim of this study was to compare the clinical outcomes between BVP and LBBAP among patients undergoing CRT. METHODS: This observational study included patients with LVEF<=35% who underwent BVP or LBBAP for the first time for Class I or II indications for CRT between Jan 2018 to June 2022 at 15 international centers.
The primary outcome was the composite endpoint of time to death or heart failure hospitalization (HFH). Secondary outcomes included endpoints of death, HFH, and echocardiographic changes..
RESULTS: A total of 1778 patients met inclusion criteria: BVP 981, LBBAP 797. The mean age was 69+-12 years, female 32%, CAD 48%, and LVEF 27+-6%.
Paced QRSd in LBBAP was significantly narrower than baseline (128+-19 vs 161+-28ms, p<0.001) and significantly narrower compared to BVP (144+-23ms, p<0.001). Following CRT, LVEF improved from 27+-6% to 41+-13% (p<0.001) with LBBAP compared to an increase from 27+-7% to 37+-12% (p<0.001) with BVP with significantly greater change from baseline with LBBAP (13+-12% vs 10+-12%, p<0.001).
On multivariable regression analysis, the primary outcome was significantly reduced with LBBAP compared BVP (20.8% vs 28%; HR 1.495; CI 1.213-1.842; p<0.001). CONCLUSIONS: LBBAP improved clinical outcomes when compared to BVP in patients with CRT indications and may be a reasonable alternative to BVP.