Efficacy of left bundle branch area pacing versus biventricular pacing in patients treated with cardiac resynchronization therapy: Select site - cohort study

Jenish P Shroff; Deep Chandh Raja; Lukah Q Tuan; Sreevilasam P Abhilash; Abhinav Mehta; Walter P Abhayaratna; Prashanthan Sanders; Rajeev K Pathak

doi:10.1016/j.hrthm.2024.02.024

Efficacy of left bundle branch area pacing versus biventricular pacing in patients treated with cardiac resynchronization therapy: Select site - cohort study

Heart Rhythm. 2024 Jun;21(6):893-900. doi: 10.1016/j.hrthm.2024.02.024. Epub 2024 Feb 15.

Authors

Jenish P Shroff¹, Deep Chandh Raja², Lukah Q Tuan¹, Sreevilasam P Abhilash³, Abhinav Mehta², Walter P Abhayaratna², Prashanthan Sanders⁴, Rajeev K Pathak⁵

Affiliations

¹ School of Medicine and Psychology, Australian National University, Australian Capital Territory, Australia; Canberra Heart Rhythm, Australian Capital Territory, Australia.
² School of Medicine and Psychology, Australian National University, Australian Capital Territory, Australia.
³ Canberra Heart Rhythm, Australian Capital Territory, Australia.
⁴ Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
⁵ School of Medicine and Psychology, Australian National University, Australian Capital Territory, Australia; Canberra Heart Rhythm, Australian Capital Territory, Australia. Electronic address: rajeev.pathak@canberraheartrhythm.com.au.

PMID: 38367889
DOI: 10.1016/j.hrthm.2024.02.024

Abstract

Background: Cardiac resynchronization therapy (CRT) is typically attempted with biventricular (BiV) pacing. One-third of patients are nonresponders. Left bundle branch area pacing (LBBAP) has been evaluated as an alternative means.

Objective: The purpose of this study was to assess the feasibility and clinical response of permanent LBBAP as an alternative to BiV pacing.

Methods: Of 479 consecutive patients referred with heart failure, 50 with BiV-CRT and 51 with LBBAP-CRT were included in this analysis after study exclusions. Quality-of-Life (QoL) assessments, echocardiographic measurements, and New York Heart Association (NYHA) class were obtained at baseline and at 6-monthly intervals.

Results: There were no differences in baseline characteristics between groups (all P > .05). Clinical outcomes such as left ventricular ejection fraction, left ventricular end-systolic volume, QoL, and NYHA class were significantly improved for both pacing groups compared to baseline. The LBBAP-CRT group showed greater improvement in left ventricular ejection fraction at 6 months (P = .001) and 12 months (P = .021), accompanied by greater reduction in left ventricular end-systolic volume (P = .007). QRS duration < 120 ms (baseline 160.82 ± 21.35 ms vs 161.08 ± 24.48 ms) was achieved in 30% in the BiV-CRT group vs 71% in the LBBAP-CRT group (P ≤ .001). Improvement in NYHA class (P = .031) and QoL index was greater (P = .014). Reduced heart failure admissions (P = .003) and health care utilization (P < .05) and improved lead performance (P < .001) were observed in the LBBAP-CRT group.

Conclusion: LBBAP-CRT is feasible and effective CRT. It results into a meaningful improvement in QoL and reduction in health care utilization. This can be offered as an alternative to BiV-CRT or potentially as first-line therapy.

Keywords: Biventricular pacing; Cardiac resynchronization therapy; Heart failure; Left bundle branch area pacing; Left bundle branch block.

Publication types

Multicenter Study

MeSH terms

Aged
Bundle of His / physiopathology
Bundle-Branch Block / physiopathology
Bundle-Branch Block / therapy
Cardiac Resynchronization Therapy* / methods
Echocardiography
Electrocardiography
Female
Follow-Up Studies
Heart Failure* / physiopathology
Heart Failure* / therapy
Humans
Male
Middle Aged
Quality of Life*
Stroke Volume* / physiology
Treatment Outcome
Ventricular Function, Left / physiology