Key result
Left bundle branch pacing generated superior electrical and mechanical resynchronization and greater LVEF improvement (26.0% vs 6.0%, p=0.001) compared to left ventricular septal pacing.
Why the study?
Left bundle branch area pacing comprises left bundle branch pacing and left ventricular septal myocardial pacing, but their respective resynchronization effects and clinical outcomes in heart failure patients with cardiac resynchronization therapy indications required assessment.
Does left bundle branch pacing (LBBP) improve electrical and mechanical resynchronization and LVEF compared to left ventricular septal myocardial pacing (LVSP) in heart failure patients with CRT indications?
Cohort (n=29)
Does left bundle branch pacing (LBBP) improve electrical and mechanical resynchronization and LVEF compared to left ventricular septal myocardial pacing (LVSP) in heart failure patients with CRT indications?
Absolute Event Rate: 26% vs 6%
p-value: p=0.001
Left bundle branch pacing provides superior electrical and mechanical resynchronization and greater LVEF improvement compared to left ventricular septal myocardial pacing in heart failure patients with CRT indications.
LBBAP may aid resynchronization in select CRT candidates; leaves open comparative efficacy versus biventricular pacing in randomized trials.
BACKGROUND: Left bundle branch area pacing (LBBAP) includes left bundle branch pacing (LBBP) and left ventricular (LV) septal myocardial pacing (LVSP). HYPOTHESIS: The study aimed to assess resynchronization effects and clinical outcomes by LBBAP in heart failure (HF) patients with cardiac resynchronization therapy (CRT) indications. METHODS: LBBAP was successfully performed in 29 consecutive patients and further classified as the LBBP-group (N = 15) and LVSP-group (N = 14) based on the LBBP criteria and novel LV conduction time measurement (LV CT, between LBBAP site and LV pacing (LVP) site). AV-interval optimized LBBP or LVSP, or LVSP combined with LVP (LVSP-LVP) was applied. LV electrical and mechanical synchrony and clinical outcomes were assessed. RESULTS: All 15 patients in the LBBP-group received optimized LBBP while 14 patients in the LVSP-group received either optimized LVSP (5) or LVSP-LVP (9). The LV CT during LBBP was significantly faster than that during LVP (p < .001), while LV CT during LVSP were similar to LVP (p = .226). The stimulus to peak LV activation time (Stim-LVAT, 71.2 ± 8.3 ms) and LV mechanical synchrony (TSI-SD, 35.3 ± 9.5 ms) during LBBP were significantly shorter than those during LVSP (Stim-LVAT 89.1 ± 19.5 ms, TSI-SD 49.8 ± 14.4 ms, both p < .05). Following 17(IQR 8) months of follow-up, the improvement of LVEF (26.0%(IQR 16.0)) in the LBBP-group was significantly greater than that in the LVSP-group (6.0%(IQR 20.8), p = .001). CONCLUSIONS: LV activation in LBBP propagated significantly faster than that of LVSP. LBBP generated superior electrical and mechanical resynchronization and better LVEF improvement over LVSP in HF patients with CRT indications.
No takes yet. Share an insight, caveat, or question.
Zhang et al. (2023) conducted a cohort in Heart failure with cardiac resynchronization therapy indications (n=29). Left bundle branch pacing (LBBP) vs. Left ventricular septal myocardial pacing (LVSP) was evaluated on Improvement of LVEF (p=0.001). Left bundle branch pacing generated superior electrical and mechanical resynchronization and greater LVEF improvement (26.0% vs 6.0%, p=0.001) compared to left ventricular septal pacing.
Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context: