Key result
LOT-CRT and BVP outperform LBBAP alone in acute hemodynamics, increasing LV dP/dtmax by ~26%.
Why the study?
LBBAP may be an alternative to BVP for CRT, but its acute hemodynamic and ECG effects compared to BVP and LOT-CRT in advanced conduction disease needed evaluation.
Does combining left bundle branch area pacing with coronary venous pacing (LOT-CRT) improve acute hemodynamic (LV dP/dtmax) and electrocardiographic (QRS shortening) response compared with biventricular pacing or left bundle branch area pacing alone in CRT candidates with advanced conduction disease?
Does combining left bundle branch area pacing with coronary venous pacing (LOT-CRT) improve acute hemodynamic (LV dP/dtmax) and electrocardiographic (QRS shortening) response compared with biventricular pacing or left bundle branch area pacing alone in CRT candidates with advanced conduction disease?
In CRT candidates with advanced conduction disease, LOT-CRT and conventional BVP provide superior acute hemodynamic improvement compared to LBBAP alone, with LOT-CRT offering the greatest QRS narrowing and incremental hemodynamic benefit particularly in patients with baseline QRS ≥171 ms or deep septal pacing capture.
Answers are grounded in this paper and cite their sources.
Supports BVP or LOT-CRT over isolated LBBAP in advanced conduction disease; leaves open whether acute hemodynamic gains translate into long-term clinical outcomes.
BACKGROUND: Left bundle branch area pacing (LBBAP) may be an alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT). We sought to compare the acute hemodynamic and ECG effects of LBBAP, BVP, and left bundle-optimized therapy CRT (LOT-CRT) in CRT candidates with advanced conduction disease. METHODS: In this multicenter study, 48 patients with either nonspecific interventricular conduction delay (n=29) or left bundle branch block (n=19) underwent acute hemodynamic testing to determine the change in left ventricular pressure maximal first derivative (LV d P /d t max ) from baseline atrial pacing to BVP, LBBAP, or LOT-CRT. RESULTS: Atrioventricular-optimized increases in LV d P /d t max for LOT-CRT (mean, 25.8% [95% CI, 20.9%–30.7%]) and BVP (26.4% [95% CI, 20.2%–32.6%]) were greater than unipolar LBBAP (19.3% [95% CI, 15.0%–23.7%]) or bipolar LBBAP (16.4% [95% CI, 12.7%–20.0%]; P ≤0.005). QRS shortening was greater in LOT-CRT (29.5 [95% CI, 23.4–35.6] ms) than unipolar LBBAP (11.9 [95% CI, 6.1–17.7] ms), bipolar LBBAP (11.7 ms [95% CI, 6.4–17.0]), or BVP (18.5 [95% CI, 11.0–25.9] ms), all P ≤0.005. Compared with patients with left bundle branch block, patients with interventricular conduction delay experienced less QRS reduction ( P =0.026) but similar improvements in LV d P /d t max ( P =0.29). Bipolar LBBAP caused anodal capture in 54% of patients and resulted in less LV d P /d t max improvement than unipolar LBBAP (18.6% versus 23.7%; P <0.001). Subclassification of LBBAP capture (European Heart Rhythm Association criteria) indicated LBBAP or LV septal pacing in 27 patients (56%) and deep septal pacing in 21 patients (44%). The hemodynamic benefit of adding left ventricular coronary vein pacing to LBBAP depended on baseline QRS duration ( P =0.031) and success of LBBAP ( P <0.004): LOT-CRT provided 14.5% (5.0%–24.1%) greater LV d P /d t max improvement and 20.8 (12.8–28.8) ms greater QRS shortening than LBBAP in subjects with QRS ≥171 ms and deep septal pacing capture type. CONCLUSIONS: In a CRT cohort with advanced conduction disease, LOT-CRT and BVP provided greater acute hemodynamic benefit than LBBAP. Subjects with wider QRS or deep septal pacing are more likely to benefit from the addition of a left ventricular coronary vein lead to implement LOT-CRT. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04905290.
No takes yet. Share an insight, caveat, or question.
Jastrzębski et al. (2024) studied Cardiac resynchronization therapy (CRT) candidates with intact atrioventricular conduction and advanced conduction disease (IVCD or LBBB) (n=48). Left bundle-optimized therapy cardiac resynchronization therapy (LOT-CRT) vs. Unipolar left bundle branch area pacing (LBBAP), bipolar LBBAP, and conventional biventricular pacing (BVP) was evaluated on Atrioventricular-optimized percentage increase in left ventricular pressure maximal first derivative (LV dP/dtmax) from baseline atrial pacing (p=<0.001). LOT-CRT and BVP increased LV dP/dtmax by 25.8% and 26.4%, respectively, providing greater acute hemodynamic benefit than unipolar or bipolar LBBAP.
Synapse has enriched 10 related papers. Consider them for comparative context: