His bundle pacing produced a significantly greater reduction in total ventricular activation time compared with left bundle branch area pacing (-46 ± 15 ms vs -36 ± 17 ms, P=0.03).
Do left bundle branch area pacing and His bundle pacing improve acute electrical and haemodynamic responses compared to biventricular pacing in patients referred for CRT?
While His bundle pacing provides better total ventricular resynchronization than left bundle branch area pacing, both modalities offer similar improvements in left ventricular electrical resynchronization and acute haemodynamics compared to traditional biventricular pacing.
p-value: p=0.03
AIMS: Left bundle branch area pacing (LBBAP) is a promising method for delivering cardiac resynchronization therapy (CRT), but its relative physiological effectiveness compared with His bundle pacing (HBP) is unknown. We conducted a within-patient comparison of HBP, LBBAP, and biventricular pacing (BVP). METHODS AND RESULTS: Patients referred for CRT were recruited. We assessed electrical response using non-invasive mapping, and acute haemodynamic response using a high-precision haemodynamic protocol. Nineteen patients were recruited: 14 male, mean LVEF of 30%. Twelve had time for BVP measurements. All three modalities reduced total ventricular activation time (TVAT), (ΔTVATHBP -43 ± 14 ms and ΔTVATLBBAP -35 ± 20 ms vs. ΔTVATBVP -19 ± 30 ms, P = 0.03 and P = 0.1, respectively). HBP produced a significantly greater reduction in TVAT compared with LBBAP in all 19 patients (-46 ± 15 ms, -36 ± 17 ms, P = 0.03). His bundle pacing and LBBAP reduced left ventricular activation time (LVAT) more than BVP (ΔLVATHBP -43 ± 16 ms, P < 0.01 vs. BVP, ΔLVATLBBAP -45 ± 17 ms, P < 0.01 vs. BVP, ΔLVATBVP -13 ± 36 ms), with no difference between HBP and LBBAP (P = 0.65). Acute systolic blood pressure was increased by all three modalities. In the 12 with BVP, greater improvement was seen with HBP and LBBAP (6.4 ± 3.8 mmHg BVP, 8.1 ± 3.8 mmHg HBP, P = 0.02 vs. BVP and 8.4 ± 8.2 mmHg for LBBAP, P = 0.3 vs. BVP), with no difference between HBP and LBBAP (P = 0.8). CONCLUSION: HBP delivered better ventricular resynchronization than LBBAP because right ventricular activation was slower during LBBAP. But LBBAP was not inferior to HBP with respect to LV electrical resynchronization and acute haemodynamic response.
Ali et al. (Fri,) conducted a other in Patients referred for cardiac resynchronization therapy (CRT) (n=19). His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) vs. Biventricular pacing (BVP) was evaluated on Reduction in total ventricular activation time (TVAT) (p=0.03). His bundle pacing produced a significantly greater reduction in total ventricular activation time compared with left bundle branch area pacing (-46 ± 15 ms vs -36 ± 17 ms, P=0.03).