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
N1 - Copyright © 2022. Published by Elsevier Inc.
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±[email protected] 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±[email protected] 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 -