Conduction system pacing vs biventricular pacing vs optimized cardiac resynchronization therapy (LOT-CRT) for heart failure patients

Background Conduction system pacing (CSP) via left bundle branch area pacing (LBBAP) may be an alternative to biventricular pacing (BiVP) for cardiac resynchronization therapy (CRT). Left bundle-optimized resynchronization therapy (LOT-CRT) may provide even more optimal resynchronization. Purpose To compare ventricular resynchronization achieved by LBBAP vs BiVP vs LOT-CRT in patients with cardiac resynchronization indications. Methods In a prospective single centre study, all patients were implanted with LOT-CRT devices, that is four electrodes were placed in the right atrium, right ventricle (defibrillation coil), interventricular septum (left bundle branch area; LBBAP) and coronary sinus branch (CS). Two to four weeks after implantation, we used a pre-specified pacing protocol in a Medtronic Cardioinsight Mapping Vest (a single-use, disposable multi-electrode vest that collects cardiac electrophysiological data from the body surface) to compare left ventricular (LV) activation time, signal propagation and hemodynamics (by invasive blood pressure measurements) by LBBAP vs BiVP vs LOT-CRT. Results Of ten patients implanted with LOT-CRT, six were with a non-ischaemic and four with an ischaemic cardiomyopathy. Mean age was 67 years (±8.5), women comprised 10% patients, mean left ventricular ejection fraction was 26.4% (±4.3), left bundle branch block was present in 60% subjects. Left ventricle activation times (ms), left ventricle signal propagation and mean values of invasive blood pressure measurements (MAP) are provided in Table 1 and Figure. Conclusions Compared with baseline all modes of stimulation (LBBAP vs BiVP vs LOT-CRT) provide significantly improved left ventricular activation times. The most homogenous left ventricular signal propagation was observed in LOT-CRT.