Key result
LBBAP-CRT is linked to a ~48% higher CRT response rate versus BiV-CRT.
Why the study?
Left bundle branch area pacing is emerging as an alternative to conventional biventricular pacing for CRT, but comparative evidence on CRT response between these modalities remains limited.
Does LBBAP-CRT improve CRT response rates and LVEF compared to conventional BiV-CRT in patients undergoing CRT implantation?
Observational (n=217)
Does LBBAP-CRT improve CRT response rates and LVEF compared to conventional BiV-CRT in patients undergoing CRT implantation?
In a real-world cohort, LBBAP-CRT was associated with a significantly higher echocardiographic responder rate compared to conventional BiV-CRT, supporting its use as an alternative for achieving reverse remodeling.
Answers are grounded in this paper and cite their sources.
LBBAP-CRT was associated with higher response rates than BiV-CRT; hypothesis-generating and requires randomized confirmation before practice change.
Background Cardiac resynchronization therapy (CRT) delivered through conduction system pacing—particularly left bundle branch area pacing (LBBAP- CRT)—is emerging as a promising alternative to conventional biventricular pacing (BiV- CRT). However, comparative evidence on CRT response between these pacing modalities remains limited. Objective To compare the response rate and improvement in left ventricular ejection fraction (LVEF) of LBBAP-CRT versus BiV-CRT patients. Methods We conducted a retrospective observational study of 217 patients who underwent CRT implantation between 2022 and 2024. Patients were categorized into LBBAP-CRT (n = 117) or BiV-CRT (n = 100). CRT response was defined as an improvement in left ventricular ejection fraction (LVEF) superior or equal to 5%. Patients were considered super-responders if they achieved a left ventricular ejection fraction >50% or improvement of more than 14.5% in LVEF after 6 months of cardiac resynchronization therapy. Statistical comparisons were performed using chi-square, t-tests and Mann-Whitney U tests where applicable. Results A total of 217 patients were included. Baseline demographic characteristics were similar between groups (mean age 73.0 ± 10.5 vs 70.9 ± 11.2 years, p = 0.155) and there was no statistically significant differences observed across gender, NYHA class, MCD, atrial fibrillation, or pre-procedural BCRD. Follow-up duration differed between groups: patients with LBBAP-CRT had a median follow-up of 15.0 months (IQR 12.7), while those with BiV-CRT had a longer follow-up of 28.6 months (IQR 23.2). Although not statistically significant on two-tailed testing (p = 0.056), the LBBAP group demonstrated a numerically greater improvement in LVEF compared with the BIV group (ΔLVEF 11.4% vs. 6.7%). The proportion of responders (variation in LVEF > 5%) was significantly higher in the LBBAP group compared to the BIV group (83.8% vs. 56.6%, p = 0.007). The proportion of super-responders (variation LVEF > 14.5%) was similar between the LBBAP and BIV groups (24.3% vs. 22.6%, p = 0.853). Conclusion In this real-world cohort, LBBAP-CRT was associated with a significantly higher responder rate and greater improvement in LVEF compared with conventional BiV-CRT. These findings support conduction system pacing as a promising alternative for achieving superior reverse remodelling, warranting confirmation in prospective randomized studies.% variation in LVEF in BIV and LBBAP CRTrate of responders in BIV and LBBAP CRT
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Primo et al. (2026) conducted an observational in Heart failure requiring cardiac resynchronization therapy (n=217). Left bundle branch area pacing (LBBAP-CRT) vs. Biventricular pacing (BiV-CRT) was evaluated on CRT response (improvement in LVEF ≥ 5%) (p=0.007). Left bundle branch area pacing (LBBAP-CRT) was associated with a significantly higher rate of CRT response compared to biventricular pacing (83.8% vs. 56.6%, p=0.007).
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