Key result
Cardiac resynchronization therapy via left bundle branch pacing resulted in a significantly higher left ventricular ejection fraction at 1 year compared to optimized biventricular pacing (49.10% vs. 43.62%, P=0.021) in patients with heart failure and left bundle branch block.
Why the study?
The study evaluated the feasibility and efficacy of cardiac resynchronization therapy via left bundle branch pacing compared with optimized biventricular pacing using an adaptive algorithm in HFrEF with left bundle branch block.
Does cardiac resynchronization therapy via left bundle branch pacing improve echocardiographic outcomes compared to optimized biventricular pacing in patients with HFrEF and LBBB?
Observational (n=100)
Yes
Does cardiac resynchronization therapy via left bundle branch pacing improve echocardiographic outcomes compared to optimized biventricular pacing in patients with HFrEF and LBBB?
Absolute Event Rate: 49.1% vs 43.62%
p-value: p=0.021
LBBP-CRT provides better electromechanical resynchronization and higher echocardiographic super-response rates than optimized biventricular pacing in patients with HFrEF and LBBB.
LBBP-CRT may offer greater LVEF gains than optimized BiVP; hypothesis-generating and should not yet change practice in HFrEF with LBBB.
AIMS: The purpose of our study was to evaluate the feasibility and efficacy of cardiac resynchronization therapy (CRT) via left bundle branch pacing (LBBP-CRT) compared with optimized biventricular pacing (BVP) with adaptive algorithm (BVP-aCRT) in heart failure with reduced left ventricular ejection fraction ≤35% (HFrEF) and left bundle branch block (LBBB). METHODS AND RESULTS: One hundred patients with HFrEF and LBBB undergoing CRT were prospectively enrolled in a non-randomized fashion and divided into two groups (LBBP-CRT, n = 49; BVP-aCRT, n = 51) in four centres. Implant characteristics and echocardiographic parameters were accessed at baseline and during 6-month and 1-year follow-up. The success rate for LBBP-CRT and BVP-aCRT was 98.00% and 91.07%. Fused LBBP had the greatest reduced QRS duration compared to BVP-aCRT (126.54 ± 11.67 vs. 102.61 ± 9.66 ms, P < 0.001). Higher absolute left ventricular ejection fraction (LVEF) and △LVEF was also achieved in LBBP-CRT than BVP-aCRT at 6-month (47.58 ± 12.02% vs. 41.24 ± 10.56%, P = 0.008; 18.52 ± 13.19% vs. 12.89 ± 9.73%, P = 0.020) and 1-year follow-up (49.10 ± 10.43% vs. 43.62 ± 11.33%, P = 0.021; 20.90 ± 11.80% vs. 15.20 ± 9.98%, P = 0.015, P = 0.015). There was no significant difference in response rate between two groups while higher super-response rate was observed in LBBP-CRT as compared to BVP-aCRT at 6 months (53.06% vs. 36.59%, P = 0.016) and 12 months (61.22% vs. 39.22%, P = 0.028) during follow-up. The pacing threshold was lower in LBBP-CRT at implant and during 1-year follow-up (both P < 0.001). Procedure-related complications and adverse clinical outcomes including heart failure hospitalization and mortality were not significantly different in two groups. CONCLUSIONS: The feasibility and efficacy of LBBP-CRT demonstrated better electromechanical resynchronization and higher clinical and echocardiographic response, especially higher super-response than BVP-aCRT in HFrEF with LBBB.
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Chen et al. (2021) conducted an observational in Heart failure with reduced left ventricular ejection fraction and left bundle branch block (n=100). Cardiac resynchronization therapy via left bundle branch pacing (LBBP-CRT) vs. Optimized biventricular pacing with adaptive algorithm (BVP-aCRT) was evaluated on Left ventricular ejection fraction (LVEF) at 1-year follow-up (p=0.021). Cardiac resynchronization therapy via left bundle branch pacing resulted in a significantly higher left ventricular ejection fraction at 1 year compared to optimized biventricular pacing (49.10% vs. 43.62%, P=0.021) in patients with heart failure and left bundle branch block.
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