Language
English
Publication Date
7-18-2023
Journal
Journal of the American College of Cardiology
DOI
10.1016/j.jacc.2023.05.006
PMID
37220862
Abstract
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.
Objectives: 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 from January 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 1,778 patients met inclusion criteria: 981 BVP, 797 LBBAP. The mean age was 69 ± 12 years, 32% were female, 48% had coronary artery disease, and mean LVEF was 27% ± 6%. Paced QRS duration in LBBAP was significantly narrower than baseline (128 ± 19 ms vs 161 ± 28 ms; P < 0.001) and significantly narrower compared to BVP (144 ± 23 ms; P < 0.001). Following CRT, LVEF improved from 27% ± 6% to 41% ± 13% (P < 0.001) with LBBAP compared with 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 with BVP (20.8% vs 28%; HR: 1.495; 95% CI: 1.213-1.842; P < 0.001).
Conclusions: LBBAP improved clinical outcomes compared with BVP in patients with CRT indications and may be a reasonable alternative to BVP.
Keywords
Humans, Female, Middle Aged, Aged, Aged, 80 and over, Male, Cardiac Resynchronization Therapy, Stroke Volume, Electrocardiography, Ventricular Function, Left, Treatment Outcome, Heart Failure, biventricular pacing, cardiac resynchronization therapy, heart failure hospitalization, left bundle branch area pacing, mortality
Published Open-Access
yes
Recommended Citation
Vijayaraman, Pugazhendhi; Sharma, Parikshit S; Cano, Óscar; et al., "Comparison of Left Bundle Branch Area Pacing and Biventricular Pacing in Candidates for Resynchronization Therapy" (2023). Faculty and Staff Publications. 4227.
https://digitalcommons.library.tmc.edu/baylor_docs/4227