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.

1st Department of Cardiology Interventional Electrocardiology and Hypertension Jagiellonian University Medical College Krakow Poland

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

Department of Cardiology Cardiovascular Research Institute Maastricht Maastricht University Medical Center Maastricht the Netherlands

Electrophysiology Laboratory University Hospital in Krakow Krakow Poland

Geisinger Heart Institute Wilkes Barre Pennsylvania USA

Hospital Universitari i Politècnic La Fe and Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares Valencia Spain

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

J Am Coll Cardiol. 2023 Jul 18;82(3):242-244. doi: 10.1016/j.jacc.2023.05.019. PubMed

References provided by Crossref.org

European Society of Cardiology (ESC) clinical consensus statement on indications for conduction system pacing, with special contribution of the European Heart Rhythm Association of the ESC and endorsed by the Asia Pacific Heart Rhythm Society, the Canadian Heart Rhythm Society, the Heart Rhythm Society, and the Latin American Heart Rhythm Society

Clinical impact and predictors of periprocedural myocardial injury among patients undergoing left bundle branch area pacing

Ultra-High-Frequency ECG in Cardiac Pacing and Cardiac Resynchronization Therapy: From Technical Concept to Clinical Application