Comparison of Left Bundle Branch Area Pacing and Biventricular Pacing in Candidates for Resynchronization Therapy
Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu pozorovací studie, časopisecké články
PubMed
37220862
DOI
10.1016/j.jacc.2023.05.006
PII: S0735-1097(23)05546-8
Knihovny.cz E-zdroje
- Klíčová slova
- biventricular pacing, cardiac resynchronization therapy, heart failure hospitalization, left bundle branch area pacing, mortality,
- MeSH
- elektrokardiografie MeSH
- funkce levé komory srdeční MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- srdeční resynchronizační terapie * MeSH
- srdeční selhání * terapie MeSH
- tepový objem MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
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.
Baylor College of Medicine and Texas Heart Institute Houston Texas USA
Baylor College of Medicine Houston Texas USA
Cardiocenter 3rd Faculty of Medicine Charles University Prague Czech Republic
Cardiology 1st Affiliated Hospital of Nanjing Medical University Nanjing Jiangsu China
Electrophysiology Laboratory University Hospital in Krakow Krakow Poland
Geisinger Heart Institute Wilkes Barre Pennsylvania USA
Hospital Universitario Virgen de las Nieves Granada Spain
National Heart and Lung Institute Imperial College London London United Kingdom
Rush University Medical Center Chicago Illinois USA
Santa Maria Della Misericordia Hospital Rovigo Italy
University of Ottawa Heart Institute Ottawa Ontario Canada
University of South Florida Morsani College of Medicine Tampa Florida USA
Velammal Medical College Hospital and Research Institute Madurai India
Virginia Commonwealth University Medical Center Richmond Virginia USA
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