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Comparison of Left Bundle Branch Area Pacing and Biventricular Pacing in Candidates for Resynchronization Therapy

P. Vijayaraman, PS. Sharma, Ó. Cano, SS. Ponnusamy, B. Herweg, F. Zanon, M. Jastrzebski, J. Zou, MG. Chelu, K. Vernooy, ZI. Whinnett, GM. Nair, M. Molina-Lerma, K. Curila, D. Zalavadia, A. Haseeb, C. Dye, SC. Vipparthy, R. Brunetti, P. Moskal, A....

. 2023 ; 82 (3) : 228-241. [pub] 20230521

Jazyk angličtina Země Spojené státy americké

Typ dokumentu pozorovací studie, časopisecké články

Perzistentní odkaz   https://www.medvik.cz/link/bmc23016867

BACKGROUND: Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is a well established therapy in patients with reduced left ventricular ejection fraction (LVEF), heart failure, and wide QRS or expected frequent ventricular pacing. Left bundle branch area pacing (LBBAP) has recently been shown to be a safe alternative to BVP. OBJECTIVES: The aim of this study was to compare the clinical outcomes between BVP and LBBAP among patients undergoing CRT. METHODS: This observational study included patients with LVEF ≤35% who underwent BVP or LBBAP for the first time for Class I or II indications for CRT from January 2018 to June 2022 at 15 international centers. The primary outcome was the composite endpoint of time to death or heart failure hospitalization (HFH). Secondary outcomes included endpoints of death, HFH, and echocardiographic changes. RESULTS: A total of 1,778 patients met inclusion criteria: 981 BVP, 797 LBBAP. The mean age was 69 ± 12 years, 32% were female, 48% had coronary artery disease, and mean LVEF was 27% ± 6%. Paced QRS duration in LBBAP was significantly narrower than baseline (128 ± 19 ms vs 161 ± 28 ms; P < 0.001) and significantly narrower compared to BVP (144 ± 23 ms; P < 0.001). Following CRT, LVEF improved from 27% ± 6% to 41% ± 13% (P < 0.001) with LBBAP compared with an increase from 27% ± 7% to 37% ± 12% (P < 0.001) with BVP, with significantly greater change from baseline with LBBAP (13% ± 12% vs 10% ± 12%; P < 0.001). On multivariable regression analysis, the primary outcome was significantly reduced with LBBAP compared with BVP (20.8% vs 28%; HR: 1.495; 95% CI: 1.213-1.842; P < 0.001). CONCLUSIONS: LBBAP improved clinical outcomes compared with BVP in patients with CRT indications and may be a reasonable alternative to BVP.

Citace poskytuje Crossref.org

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$a Vijayaraman, Pugazhendhi $u Geisinger Heart Institute, Wilkes Barre, Pennsylvania, USA. Electronic address: pvijayaraman1@geisinger.edu
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$a Comparison of Left Bundle Branch Area Pacing and Biventricular Pacing in Candidates for Resynchronization Therapy / $c P. Vijayaraman, PS. Sharma, Ó. Cano, SS. Ponnusamy, B. Herweg, F. Zanon, M. Jastrzebski, J. Zou, MG. Chelu, K. Vernooy, ZI. Whinnett, GM. Nair, M. Molina-Lerma, K. Curila, D. Zalavadia, A. Haseeb, C. Dye, SC. Vipparthy, R. Brunetti, P. Moskal, A. Ross, A. van Stipdonk, J. George, YK. Qadeer, M. Mumtaz, J. Kolominsky, SA. Zahra, M. Golian, L. Marcantoni, FA. Subzposh, KA. Ellenbogen
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$a BACKGROUND: Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is a well established therapy in patients with reduced left ventricular ejection fraction (LVEF), heart failure, and wide QRS or expected frequent ventricular pacing. Left bundle branch area pacing (LBBAP) has recently been shown to be a safe alternative to BVP. OBJECTIVES: The aim of this study was to compare the clinical outcomes between BVP and LBBAP among patients undergoing CRT. METHODS: This observational study included patients with LVEF ≤35% who underwent BVP or LBBAP for the first time for Class I or II indications for CRT from January 2018 to June 2022 at 15 international centers. The primary outcome was the composite endpoint of time to death or heart failure hospitalization (HFH). Secondary outcomes included endpoints of death, HFH, and echocardiographic changes. RESULTS: A total of 1,778 patients met inclusion criteria: 981 BVP, 797 LBBAP. The mean age was 69 ± 12 years, 32% were female, 48% had coronary artery disease, and mean LVEF was 27% ± 6%. Paced QRS duration in LBBAP was significantly narrower than baseline (128 ± 19 ms vs 161 ± 28 ms; P < 0.001) and significantly narrower compared to BVP (144 ± 23 ms; P < 0.001). Following CRT, LVEF improved from 27% ± 6% to 41% ± 13% (P < 0.001) with LBBAP compared with an increase from 27% ± 7% to 37% ± 12% (P < 0.001) with BVP, with significantly greater change from baseline with LBBAP (13% ± 12% vs 10% ± 12%; P < 0.001). On multivariable regression analysis, the primary outcome was significantly reduced with LBBAP compared with BVP (20.8% vs 28%; HR: 1.495; 95% CI: 1.213-1.842; P < 0.001). CONCLUSIONS: LBBAP improved clinical outcomes compared with BVP in patients with CRT indications and may be a reasonable alternative to BVP.
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$a Sharma, Parikshit S $u Rush University Medical Center, Chicago, Illinois, USA
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$a Cano, Óscar $u Hospital Universitari i Politècnic La Fe and Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares, Valencia, Spain
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$a Ponnusamy, Shunmuga Sundaram $u Velammal Medical College Hospital and Research Institute, Madurai, India
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$a Herweg, Bengt $u University of South Florida Morsani College of Medicine, Tampa, Florida, USA
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$a Zanon, Francesco $u Santa Maria Della Misericordia Hospital, Rovigo, Italy
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$a Jastrzebski, Marek $u First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
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$a Zou, Jiangang $u Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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$a Chelu, Mihail G $u Baylor College of Medicine and Texas Heart Institute, Houston, Texas, USA
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$a Vernooy, Kevin $u Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
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$a Whinnett, Zachary I $u National Heart and Lung Institute, Imperial College London, London, United Kingdom
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$a Nair, Girish M $u University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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$a Molina-Lerma, Manuel $u Hospital Universitario Virgen de las Nieves, Granada, Spain
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$a Curila, Karol $u Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic
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$a Zalavadia, Dipen $u Geisinger Heart Institute, Wilkes Barre, Pennsylvania, USA
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$a Haseeb, Abdul $u Geisinger Heart Institute, Wilkes Barre, Pennsylvania, USA
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$a Dye, Cicely $u Rush University Medical Center, Chicago, Illinois, USA
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$a Vipparthy, Sharath C $u Rush University Medical Center, Chicago, Illinois, USA
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$a Brunetti, Ryan $u University of South Florida Morsani College of Medicine, Tampa, Florida, USA
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$a Moskal, Pawel $u Electrophysiology Laboratory, University Hospital in Krakow, Krakow, Poland
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$a Ross, Alexandra $u National Heart and Lung Institute, Imperial College London, London, United Kingdom
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$a van Stipdonk, Antonius $u Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
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$a George, Jerin $u Baylor College of Medicine, Houston, Texas, USA
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$a Qadeer, Yusuf K $u Baylor College of Medicine, Houston, Texas, USA
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$a Mumtaz, Mishal $u University of South Florida Morsani College of Medicine, Tampa, Florida, USA
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$a Kolominsky, Jeffrey $u Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
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$a Zahra, Syeda A $u National Heart and Lung Institute, Imperial College London, London, United Kingdom
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$a Golian, Mehrdad $u University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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$a Marcantoni, Lina $u Santa Maria Della Misericordia Hospital, Rovigo, Italy
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$a Subzposh, Faiz A $u Geisinger Heart Institute, Wilkes Barre, Pennsylvania, USA
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$a Ellenbogen, Kenneth A $u Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
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