BACKGROUND: Left bundle branch pacing (LBBP) is a novel physiological pacing technique which may serve as an alternative to cardiac resynchronization therapy (CRT) by biventricular pacing (BVP). This study assessed ventricular activation patterns and echocardiographic and clinical outcomes of LBBP and compared this to BVP. METHODS: Fifty consecutive patients underwent LBBP or BVP for CRT. Ventricular activation mapping was obtained by ultra-high-frequency ECG (UHF-ECG). Functional and echocardiographic outcomes and hospitalization for heart failure and all-cause mortality after one year from implantation were evaluated. RESULTS: LBBP resulted in greater resynchronization vs BVP (QRS width: 170 ± 16 ms to 128 ± 20 ms vs 174 ± 15 to 144 ± 17 ms, p = 0.002 (LBBP vs BVP); e-DYS 81 ± 17 ms to 0 ± 32 ms vs 77 ± 18 to 16 ± 29 ms, p = 0.016 (LBBP vs BVP)). Improvement in LVEF (from 28 ± 8 to 42 ± 10 percent vs 28 ± 9 to 36 ± 12 percent, LBBP vs BVP, p = 0.078) was similar. Improvement in NYHA function class (from 2.4 to 1.5 and from 2.3 to 1.5 (LBBP vs BVP)), hospitalization for heart failure and all-cause mortality were comparable in both groups. CONCLUSIONS: Ventricular dyssynchrony imaging is an appropriate way to gain a better insight into activation patterns of LBBP and BVP. LBBP resulted in greater resynchronization (e-DYS and QRS duration) with comparable improvement in LVEF, NYHA functional class, hospitalization for heart failure and all-cause mortality at one year of follow up.

Department of Cardiology Catharina Hospital Eindhoven the Netherlands

The Czech Academy of Sciences Institute of Scientific Instruments Brno Czech Republic

Zobrazit více v PubMed

Abraham W.T., Fisher W.G., Smith A.L., Delurgio D.B., Leon A.R., Loh E., et al. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002;346(24):1845–1853. PubMed

Gervais R., Leclercq C., Shankar A., Jacobs S., Eiskjaer H., Johannessen A., et al. Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial. Eur J Heart Fail. 2009;11(7):699–705. PubMed

Ploux S., Eschalier R., Whinnett Z.I., Lumens J., Derval N., Sacher F., et al. Electrical dyssynchrony induced by biventricular pacing: implications for patient selection and therapy improvement. Heart Rhythm. 2015;12(4):782–791. PubMed

Jones S., Lumens J., Sohaib S.M.A., Finegold J.A., Kanagaratnam P., Tanner M., et al. Cardiac resynchronization therapy: mechanisms of action and scope for further improvement in cardiac function. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2017;19(7):1178–1186. PubMed PMC

Jurak P., Curila K., Leinveber P., Prinzen F.W., Viscor I., Plesinger F., et al. Novel ultra-high-frequency electrocardiogram tool for the description of the ventricular depolarization pattern before and during cardiac resynchronization. J Cardiovasc Electrophysiol. 2020;31(1):300–307. PubMed

Strauss D.G., Selvester R.H., Wagner G.S. Defining left bundle branch block in the era of cardiac resynchronization therapy. Am J Cardiol. 2011;107(6):927–934. PubMed

Rademakers L.M., Bracke F.A. Cephalic vein access by modified Seldinger technique for lead implantations. Pacing Clin Electrophysiol : PACE (Pacing Clin Electrophysiol) 2021;44(4):607–613. PubMed

Rademakers L.M., van den Broek J., Bracke F.A. Left bundle branch pacing as an alternative to biventricular pacing for cardiac resynchronisation therapy. Neth Heart J. 2023;31(4):140–149. PubMed PMC

Jastrzebski M., Burri H., Kielbasa G., Curila K., Moskal P., Bednarek A., et al. 2021. The V6-V1 interpeak interval: a novel criterion for the diagnosis of left bundle branch capture. (Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology). PubMed PMC

Lang R.M., Badano L.P., Mor-Avi V., Afilalo J., Armstrong A., Ernande L., et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imag. 2015;16(3):233–270. PubMed

Elliott M.K., Strocchi M., Sieniewicz B.J., Sidhu B., Mehta V., Wijesuriya N., et al. Biventricular endocardial pacing and left bundle branch area pacing for cardiac resynchronization: mechanistic insights from electrocardiographic imaging, acute hemodynamic response, and magnetic resonance imaging. Heart Rhythm. 2023;20(2):207–216. PubMed

Liang Y., Wang J., Gong X., Lu H., Yu Z., Zhang L., et al. Left bundle branch pacing versus biventricular pacing for acute cardiac resynchronization in patients with heart failure. Circ Arrhythm Electrophysiol. 2022;15(11) PubMed PMC

Curila K., Jurak P., Prinzen F., Jastrzebski M., Waldauf P., Halamek J., et al. Bipolar anodal septal pacing with direct LBB capture preserves physiological ventricular activation better than unipolar left bundle branch pacing. Front Cardiovasc Med. 2023;10 PubMed PMC

Sussenbek O., Rademakers L., Waldauf P., Jurak P., Smisek R., Stros P., et al. Left bundle branch area pacing results in more physiological ventricular activation than biventricular pacing in patients with left bundle branch block heart failure. Eur Heart J Suppl. 2023;25(Suppl E):E17–E24. PubMed PMC

Chen K., Li Y. How to implant left bundle branch pacing lead in routine clinical practice. J Cardiovasc Electrophysiol. 2019;30(11):2569–2577. PubMed

Chen X., Wu S., Su L., Su Y., Huang W. The characteristics of the electrocardiogram and the intracardiac electrogram in left bundle branch pacing. J Cardiovasc Electrophysiol. 2019;30(7):1096–1101. PubMed

Jastrzebski M., Kielbasa G., Curila K., Moskal P., Bednarek A., Rajzer M., et al. Physiology-based electrocardiographic criteria for left bundle branch capture. Heart Rhythm. 2021;18(6):935–943. PubMed

Ghossein M.A., van Stipdonk A.M.W., Plesinger F., Kloosterman M., Wouters P.C., Salden O.A.E., et al. Reduction in the QRS area after cardiac resynchronization therapy is associated with survival and echocardiographic response. J Cardiovasc Electrophysiol. 2021;32(3):813–822. PubMed PMC

Jastrzebski M., Moskal P., Huybrechts W., Curila K., Sreekumar P., Rademakers L.M., et al. Left bundle branch-optimized cardiac resynchronization therapy (LOT-CRT): results from an international LBBAP collaborative study group. Heart Rhythm. 2022;19(1):13–21. PubMed

Parlavecchio A., Vetta G., Caminiti R., Coluccia G., Magnocavallo M., Ajello M., et al. Left bundle branch pacing versus biventricular pacing for cardiac resynchronization therapy: a systematic review and meta-analysis. Pacing Clin Electrophysiol. 2023;46(5):432–439. PubMed

Vijayaraman P., Ponnusamy S., Cano O., Sharma P.S., Naperkowski A., Subsposh F.A., et al. Left bundle branch area pacing for cardiac resynchronization therapy: results from the international LBBAP collaborative study group. JACC Clin Electrophysiol. 2021;7(2):135–147. PubMed

Chen X., Ye Y., Wang Z., Jin Q., Qiu Z., Wang J., et al. Cardiac resynchronization therapy via left bundle branch pacing vs. optimized biventricular pacing with adaptive algorithm in heart failure with left bundle branch block: a prospective, multi-centre, observational study. Europace. 2022;24(5):807–816. PubMed PMC

Hu Q., You H., Chen K., Dai Y., Lu W., Li Y., et al. Distance between the lead-implanted site and tricuspid valve annulus in patients with left bundle branch pacing: effects on postoperative tricuspid regurgitation deterioration. Heart Rhythm. 2023;20(2):217–223. PubMed

Wang Y., Zhu H., Hou X., Wang Z., Zou F., Qian Z., et al. Randomized trial of left bundle branch vs biventricular pacing for cardiac resynchronization therapy. J Am Coll Cardiol. 2022;80(13):1205–1216. PubMed

Raphael C., Briscoe C., Davies J., Ian Whinnett Z., Manisty C., Sutton R., et al. Limitations of the New York Heart Association functional classification system and self-reported walking distances in chronic heart failure. Heart. 2007;93(4):476–482. PubMed PMC

Li X., Qiu C., Xie R., Ma W., Wang Z., Li H., et al. Left bundle branch area pacing delivery of cardiac resynchronization therapy and comparison with biventricular pacing. ESC Heart Fail. 2020;7(4):1711–1722. PubMed PMC

Upadhyay G.A., Cherian T., Shatz D.Y., Beaser A.D., Aziz Z., Ozcan C., et al. Intracardiac delineation of septal conduction in left bundle-branch block patterns. Circulation. 2019;139(16):1876–1888. PubMed