Rescue Left Bundle Branch Area Pacing in Coronary Venous Lead Failure or Non-response to Biventricular Pacing: Results From International LBBAP Collaborative Study Group

Pugazhendhi Vijayaraman; Bengt Herweg; Atul Verma; Parikshit S Sharma; Syeda Atiqa Batul; Shunmuga Sundaram Ponnusamy; Robert D Schaller; Oscar Cano; Manuel Molina-Lerma; Karol Curila; Wim Huybrechts; David R Wilson; Leonard M Rademakers; Praveen Sreekumar; Gaurav Upadhyay; Kevin Vernooy; Faiz A Subzposh; Weijian Huang; Marek Jastrzebski; Kenneth A Ellenbogen

doi:10.1016/j.hrthm.2022.04.024

Rescue Left Bundle Branch Area Pacing in Coronary Venous Lead Failure or Non-response to Biventricular Pacing: Results From International LBBAP Collaborative Study Group

Pugazhendhi Vijayaraman^*, Bengt Herweg, Atul Verma, Parikshit S Sharma, Syeda Atiqa Batul, Shunmuga Sundaram Ponnusamy, Robert D Schaller, Oscar Cano, Manuel Molina-Lerma, Karol Curila, Wim Huybrechts, David R Wilson, Leonard M Rademakers, Praveen Sreekumar, Gaurav Upadhyay, Kevin Vernooy, Faiz A Subzposh, Weijian Huang, Marek Jastrzebski, Kenneth A Ellenbogen

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) is effective in patients with heart failure, left bundle branch block (LBBB) and reduced left ventricular function. Left bundle branch area pacing (LBBAP) has been reported as an alternative option for CRT.

OBJECTIVE: The aim of this study was to assess the feasibility and outcomes of LBBAP in patients who failed conventional BVP due to coronary venous lead complications or were non-responders to BVP.

METHODS: At 16 international centers, LBBAP was attempted in patients with conventional CRT indication who failed BVP due to either, coronary venous (CV) lead complications, or lack of therapeutic response to BVP. We are reporting heart failure hospitalizations (HFH) and death, echocardiographic outcomes, procedural data, pacing parameters, and lead complications including CV lead failure.

RESULTS: LBBAP was successfully performed in 200 patients (CV lead failures-156; non-responders-44): age 68±11years, female-35%, LBBB-55%, RVP-23%, ischemic cardiomyopathy-28%, nonischemic cardiomyopathy-63%, LVEF ≤35% in 80%. Procedure and fluoroscopy duration were 119.5±59.6 and 25.7±18.5 min. LBBAP threshold and R-wave amplitudes were 0.68±0.35V@0.45ms and 10.4±5mV at implant and remained stable during mean follow-up of 12±10.1 months. LBBAP resulted in significant QRS narrowing from 170±28ms to 139±25ms (p<0.001) with V6 R-wave peak times of 85±17ms. LVEF improved from 29±10% at baseline to 40±12% (p<0.001) during follow-up. The risk for death or HFH was lower in CV lead failure compared to non-responders (HR-0.357;95%CI 0.168-0.756,p=0.007) CONCLUSION: LBBAP is a viable alternative for CRT in patients who failed conventional BVP due to CV lead failure or were non-responders.

Original language	English
Pages (from-to)	1272-1280
Number of pages	9
Journal	Heart Rhythm
Volume	19
Issue number	8
Early online date	27 Apr 2022
DOIs	https://doi.org/10.1016/j.hrthm.2022.04.024
Publication status	Published - Aug 2022

Keywords

Biventricular pacing failure
CARDIAC-RESYNCHRONIZATION THERAPY
Cardiac resynchronization therapy
Heart failure
Left bundle branch area pacing
MORBIDITY
MORTALITY
Nonresponder

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10.1016/j.hrthm.2022.04.024

Cite this

Vijayaraman, P., Herweg, B., Verma, A., Sharma, P. S., Batul, S. A., Ponnusamy, S. S., Schaller, R. D., Cano, O., Molina-Lerma, M., Curila, K., Huybrechts, W., Wilson, D. R., Rademakers, L. M., Sreekumar, P., Upadhyay, G., Vernooy, K., Subzposh, F. A., Huang, W., Jastrzebski, M., & Ellenbogen, K. A. (2022). Rescue Left Bundle Branch Area Pacing in Coronary Venous Lead Failure or Non-response to Biventricular Pacing: Results From International LBBAP Collaborative Study Group. Heart Rhythm, 19(8), 1272-1280. https://doi.org/10.1016/j.hrthm.2022.04.024

@article{1272b1e0cc0b4174a066e65c0bed1a5a,

title = "Rescue Left Bundle Branch Area Pacing in Coronary Venous Lead Failure or Non-response to Biventricular Pacing: Results From International LBBAP Collaborative Study Group",

abstract = "BACKGROUND: Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) is effective in patients with heart failure, left bundle branch block (LBBB) and reduced left ventricular function. Left bundle branch area pacing (LBBAP) has been reported as an alternative option for CRT.OBJECTIVE: The aim of this study was to assess the feasibility and outcomes of LBBAP in patients who failed conventional BVP due to coronary venous lead complications or were non-responders to BVP.METHODS: At 16 international centers, LBBAP was attempted in patients with conventional CRT indication who failed BVP due to either, coronary venous (CV) lead complications, or lack of therapeutic response to BVP. We are reporting heart failure hospitalizations (HFH) and death, echocardiographic outcomes, procedural data, pacing parameters, and lead complications including CV lead failure.RESULTS: LBBAP was successfully performed in 200 patients (CV lead failures-156; non-responders-44): age 68±11years, female-35%, LBBB-55%, RVP-23%, ischemic cardiomyopathy-28%, nonischemic cardiomyopathy-63%, LVEF ≤35% in 80%. Procedure and fluoroscopy duration were 119.5±59.6 and 25.7±18.5 min. LBBAP threshold and R-wave amplitudes were 0.68±0.35V@0.45ms and 10.4±5mV at implant and remained stable during mean follow-up of 12±10.1 months. LBBAP resulted in significant QRS narrowing from 170±28ms to 139±25ms (p<0.001) with V6 R-wave peak times of 85±17ms. LVEF improved from 29±10% at baseline to 40±12% (p<0.001) during follow-up. The risk for death or HFH was lower in CV lead failure compared to non-responders (HR-0.357;95%CI 0.168-0.756,p=0.007) CONCLUSION: LBBAP is a viable alternative for CRT in patients who failed conventional BVP due to CV lead failure or were non-responders.",

keywords = "Biventricular pacing failure, CARDIAC-RESYNCHRONIZATION THERAPY, Cardiac resynchronization therapy, Heart failure, Left bundle branch area pacing, MORBIDITY, MORTALITY, Nonresponder",

author = "Pugazhendhi Vijayaraman and Bengt Herweg and Atul Verma and Sharma, {Parikshit S} and Batul, {Syeda Atiqa} and Ponnusamy, {Shunmuga Sundaram} and Schaller, {Robert D} and Oscar Cano and Manuel Molina-Lerma and Karol Curila and Wim Huybrechts and Wilson, {David R} and Rademakers, {Leonard M} and Praveen Sreekumar and Gaurav Upadhyay and Kevin Vernooy and Subzposh, {Faiz A} and Weijian Huang and Marek Jastrzebski and Ellenbogen, {Kenneth A}",

note = "Copyright {\textcopyright} 2022. Published by Elsevier Inc.",

year = "2022",

month = aug,

doi = "10.1016/j.hrthm.2022.04.024",

language = "English",

volume = "19",

pages = "1272--1280",

journal = "Heart Rhythm",

issn = "1547-5271",

publisher = "Elsevier Science",

number = "8",

}

Vijayaraman, P, Herweg, B, Verma, A, Sharma, PS, Batul, SA, Ponnusamy, SS, Schaller, RD, Cano, O, Molina-Lerma, M, Curila, K, Huybrechts, W, Wilson, DR, Rademakers, LM, Sreekumar, P, Upadhyay, G, Vernooy, K, Subzposh, FA, Huang, W, Jastrzebski, M & Ellenbogen, KA 2022, 'Rescue Left Bundle Branch Area Pacing in Coronary Venous Lead Failure or Non-response to Biventricular Pacing: Results From International LBBAP Collaborative Study Group', Heart Rhythm, vol. 19, no. 8, pp. 1272-1280. https://doi.org/10.1016/j.hrthm.2022.04.024

Rescue Left Bundle Branch Area Pacing in Coronary Venous Lead Failure or Non-response to Biventricular Pacing: Results From International LBBAP Collaborative Study Group. / Vijayaraman, Pugazhendhi; Herweg, Bengt; Verma, Atul et al.
In: Heart Rhythm, Vol. 19, No. 8, 08.2022, p. 1272-1280.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Rescue Left Bundle Branch Area Pacing in Coronary Venous Lead Failure or Non-response to Biventricular Pacing

T2 - Results From International LBBAP Collaborative Study Group

AU - Vijayaraman, Pugazhendhi

AU - Herweg, Bengt

AU - Verma, Atul

AU - Sharma, Parikshit S

AU - Batul, Syeda Atiqa

AU - Ponnusamy, Shunmuga Sundaram

AU - Schaller, Robert D

AU - Cano, Oscar

AU - Molina-Lerma, Manuel

AU - Curila, Karol

AU - Huybrechts, Wim

AU - Wilson, David R

AU - Rademakers, Leonard M

AU - Sreekumar, Praveen

AU - Upadhyay, Gaurav

AU - Vernooy, Kevin

AU - Subzposh, Faiz A

AU - Huang, Weijian

AU - Jastrzebski, Marek

AU - Ellenbogen, Kenneth A

PY - 2022/8

Y1 - 2022/8

N2 - BACKGROUND: Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) is effective in patients with heart failure, left bundle branch block (LBBB) and reduced left ventricular function. Left bundle branch area pacing (LBBAP) has been reported as an alternative option for CRT.OBJECTIVE: The aim of this study was to assess the feasibility and outcomes of LBBAP in patients who failed conventional BVP due to coronary venous lead complications or were non-responders to BVP.METHODS: At 16 international centers, LBBAP was attempted in patients with conventional CRT indication who failed BVP due to either, coronary venous (CV) lead complications, or lack of therapeutic response to BVP. We are reporting heart failure hospitalizations (HFH) and death, echocardiographic outcomes, procedural data, pacing parameters, and lead complications including CV lead failure.RESULTS: LBBAP was successfully performed in 200 patients (CV lead failures-156; non-responders-44): age 68±11years, female-35%, LBBB-55%, RVP-23%, ischemic cardiomyopathy-28%, nonischemic cardiomyopathy-63%, LVEF ≤35% in 80%. Procedure and fluoroscopy duration were 119.5±59.6 and 25.7±18.5 min. LBBAP threshold and R-wave amplitudes were 0.68±0.35V@0.45ms and 10.4±5mV at implant and remained stable during mean follow-up of 12±10.1 months. LBBAP resulted in significant QRS narrowing from 170±28ms to 139±25ms (p<0.001) with V6 R-wave peak times of 85±17ms. LVEF improved from 29±10% at baseline to 40±12% (p<0.001) during follow-up. The risk for death or HFH was lower in CV lead failure compared to non-responders (HR-0.357;95%CI 0.168-0.756,p=0.007) CONCLUSION: LBBAP is a viable alternative for CRT in patients who failed conventional BVP due to CV lead failure or were non-responders.

AB - BACKGROUND: Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) is effective in patients with heart failure, left bundle branch block (LBBB) and reduced left ventricular function. Left bundle branch area pacing (LBBAP) has been reported as an alternative option for CRT.OBJECTIVE: The aim of this study was to assess the feasibility and outcomes of LBBAP in patients who failed conventional BVP due to coronary venous lead complications or were non-responders to BVP.METHODS: At 16 international centers, LBBAP was attempted in patients with conventional CRT indication who failed BVP due to either, coronary venous (CV) lead complications, or lack of therapeutic response to BVP. We are reporting heart failure hospitalizations (HFH) and death, echocardiographic outcomes, procedural data, pacing parameters, and lead complications including CV lead failure.RESULTS: LBBAP was successfully performed in 200 patients (CV lead failures-156; non-responders-44): age 68±11years, female-35%, LBBB-55%, RVP-23%, ischemic cardiomyopathy-28%, nonischemic cardiomyopathy-63%, LVEF ≤35% in 80%. Procedure and fluoroscopy duration were 119.5±59.6 and 25.7±18.5 min. LBBAP threshold and R-wave amplitudes were 0.68±0.35V@0.45ms and 10.4±5mV at implant and remained stable during mean follow-up of 12±10.1 months. LBBAP resulted in significant QRS narrowing from 170±28ms to 139±25ms (p<0.001) with V6 R-wave peak times of 85±17ms. LVEF improved from 29±10% at baseline to 40±12% (p<0.001) during follow-up. The risk for death or HFH was lower in CV lead failure compared to non-responders (HR-0.357;95%CI 0.168-0.756,p=0.007) CONCLUSION: LBBAP is a viable alternative for CRT in patients who failed conventional BVP due to CV lead failure or were non-responders.

KW - Biventricular pacing failure

KW - CARDIAC-RESYNCHRONIZATION THERAPY

KW - Cardiac resynchronization therapy

KW - Heart failure

KW - Left bundle branch area pacing

KW - MORBIDITY

KW - MORTALITY

KW - Nonresponder

U2 - 10.1016/j.hrthm.2022.04.024

DO - 10.1016/j.hrthm.2022.04.024

M3 - Article

C2 - 35504539

SN - 1547-5271

VL - 19

SP - 1272

EP - 1280

JO - Heart Rhythm

JF - Heart Rhythm

IS - 8

ER -