TY - JOUR
T1 - Comparison of Left Bundle Branch Area Pacing and Biventricular Pacing in Candidates for Resynchronization Therapy
AU - Vijayaraman, Pugazhendhi
AU - Sharma, Parikshit S.
AU - Cano, Oscar
AU - Ponnusamy, Shunmuga Sundaram
AU - Herweg, Bengt
AU - Zanon, Francesco
AU - Jastrzebski, Marek
AU - Zou, Jiangang
AU - Chelu, Mihail G.
AU - Vernooy, Kevin
AU - Whinnett, Zachary I.
AU - Nair, Girish M.
AU - Molina-Lerma, Manuel
AU - Curila, Karol
AU - Zalavadia, Dipen
AU - Haseeb, Abdul
AU - Dye, Cicely
AU - Vipparthy, Sharath C.
AU - Brunetti, Ryan
AU - Moskal, Pawel
AU - Ross, Alexandra
AU - van Stipdonk, Antonius
AU - George, Jerin
AU - Qadeer, Yusuf K.
AU - Mumtaz, Mishal
AU - Kolominsky, Jeffrey
AU - Zahra, Syeda A.
AU - Golian, Mehrdad
AU - Marcantoni, Lina
AU - Subzposh, Faiz A.
AU - Ellenbogen, Kenneth A.
PY - 2023/7/18
Y1 - 2023/7/18
N2 - 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 ven-tricular 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 & PLUSMN; 12 years, 32% were female, 48% had coronary artery disease, and mean LVEF was 27% & PLUSMN; 6%. Paced QRS duration in LBBAP was significantly narrower than baseline (128 & PLUSMN; 19 ms vs 161 & PLUSMN; 28 ms; P < 0.001) and significantly narrower compared to BVP (144 & PLUSMN; 23 ms; P < 0.001). Following CRT, LVEF improved from 27% & PLUSMN; 6% to 41% & PLUSMN; 13% (P < 0.001) with LBBAP compared with an increase from 27% & PLUSMN; 7% to 37% & PLUSMN; 12% (P < 0.001) with BVP, with significantly greater change from baseline with LBBAP (13% & PLUSMN; 12% vs 10% & PLUSMN; 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. (J Am Coll Cardiol 2023;82:228-241) & COPY; 2023 by the American College of Cardiology Foundation.
AB - 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 ven-tricular 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 & PLUSMN; 12 years, 32% were female, 48% had coronary artery disease, and mean LVEF was 27% & PLUSMN; 6%. Paced QRS duration in LBBAP was significantly narrower than baseline (128 & PLUSMN; 19 ms vs 161 & PLUSMN; 28 ms; P < 0.001) and significantly narrower compared to BVP (144 & PLUSMN; 23 ms; P < 0.001). Following CRT, LVEF improved from 27% & PLUSMN; 6% to 41% & PLUSMN; 13% (P < 0.001) with LBBAP compared with an increase from 27% & PLUSMN; 7% to 37% & PLUSMN; 12% (P < 0.001) with BVP, with significantly greater change from baseline with LBBAP (13% & PLUSMN; 12% vs 10% & PLUSMN; 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. (J Am Coll Cardiol 2023;82:228-241) & COPY; 2023 by the American College of Cardiology Foundation.
KW - biventricular pacing
KW - cardiac resynchronization therapy
KW - heart failure hospitalization
KW - left bundle branch area pacing
KW - mortality
KW - CARDIAC-RESYNCHRONIZATION
KW - HEART-FAILURE
U2 - 10.1016/j.jacc.2023.05.006
DO - 10.1016/j.jacc.2023.05.006
M3 - Article
C2 - 37220862
SN - 0735-1097
VL - 82
SP - 228
EP - 241
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 3
ER -