Left bundle branch area pacing significantly reduced the composite of death or heart failure hospitalization compared with biventricular pacing (20.8% vs 28%; HR 1.495; 95% CI 1.213-1.842; P<0.001).
Observational (n=1,778)
Yes
Does left bundle branch area pacing reduce the composite of death or heart failure hospitalization compared to biventricular pacing in patients with LVEF ≤35% and CRT indications?
Left bundle branch area pacing is associated with a lower risk of death or heart failure hospitalization and greater improvement in LVEF compared to traditional biventricular pacing in patients with CRT indications.
Effect estimate: HR 1.495 (95% CI 1.213-1.842)
Absolute Event Rate: 20.8% vs 28%
p-value: p=<0.001
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 ven-tricular 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. (J Am Coll Cardiol 2023;82:228-241) 2023 by the American College of Cardiology Foundation. Original language English Pages (from-to) 228-241 Number of pages 14 Journal Journal of the American College of Cardiology Volume 82 Issue number 3 Early online date 1 Jul 2023 DOIs https://doi.org/10.1016/j.jacc.2023.05.006 Publication status Published - 18 Jul 2023 Keywords biventricular pacing cardiac resynchronization therapy heart failure hospitalization left bundle branch area pacing mortality CARDIAC-RESYNCHRONIZATION HEART-FAILURE
Vijayaraman et al. (Sun,) conducted a observational in Reduced left ventricular ejection fraction with indications for cardiac resynchronization therapy (n=1,778). Left bundle branch area pacing (LBBAP) vs. Biventricular pacing (BVP) was evaluated on Composite endpoint of time to death or heart failure hospitalization (HFH) (HR 1.495, 95% CI 1.213-1.842, p=<0.001). Left bundle branch area pacing significantly reduced the composite of death or heart failure hospitalization compared with biventricular pacing (20.8% vs 28%; HR 1.495; 95% CI 1.213-1.842; P<0.001).
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