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

Abstract

Aims The purpose of our study was to evaluate the feasibility and efficacy of cardiac resynchronization therapy (CRT) via left bundle branch pacing (LBBP-CRT) compared with optimized biventricular pacing (BVP) with adaptive algorithm (BVP-aCRT) in heart failure with reduced left ventricular ejection fraction ≤35% (HFrEF) and left bundle branch block (LBBB). Methods and results One hundred patients with HFrEF and LBBB undergoing CRT were prospectively enrolled in a non-randomized fashion and divided into two groups (LBBP-CRT, n = 49; BVP-aCRT, n = 51) in four centres. Implant characteristics and echocardiographic parameters were accessed at baseline and during 6-month and 1-year follow-up. The success rate for LBBP-CRT and BVP-aCRT was 98.00% and 91.07%. Fused LBBP had the greatest reduced QRS duration compared to BVP-aCRT (126.54 ± 11.67 vs. 102.61 ± 9.66 ms, P < 0.001). Higher absolute left ventricular ejection fraction (LVEF) and △LVEF was also achieved in LBBP-CRT than BVP-aCRT at 6-month (47.58 ± 12.02% vs. 41.24 ± 10.56%, P = 0.008; 18.52 ± 13.19% vs. 12.89 ± 9.73%, P = 0.020) and 1-year follow-up (49.10 ± 10.43% vs. 43.62 ± 11.33%, P = 0.021; 20.90 ± 11.80% vs. 15.20 ± 9.98%, P = 0.015, P = 0.015). There was no significant difference in response rate between two groups while higher super-response rate was observed in LBBP-CRT as compared to BVP-aCRT at 6 months (53.06% vs. 36.59%, P = 0.016) and 12 months (61.22% vs. 39.22%, P = 0.028) during follow-up. The pacing threshold was lower in LBBP-CRT at implant and during 1-year follow-up (both P < 0.001). Procedure-related complications and adverse clinical outcomes including heart failure hospitalization and mortality were not significantly different in two groups. Conclusions The feasibility and efficacy of LBBP-CRT demonstrated better electromechanical resynchronization and higher clinical and echocardiographic response, especially higher super-response than BVP-aCRT in HFrEF with LBBB.

Evaluation of electrophysiological characteristics and ventricular synchrony: An intrapatient‐controlled study during His‐Purkinje conduction system pacing versus right ventricular pacing

“…5 Recent studies have also demonstrated that HPCSP significantly improved heart function in heart failure patients with left bundle branch block (LBBB), 6 , 7 , 8 and even better than BVP. 9 , 10 Theoretically, HBP is the most physiological pacing mode and it could achieve the same narrow QRS complex as the intrinsic and correct LBBB or right bundle branch block (RBBB) as well. However, pacing safety concerning high pacing threshold and low R wave amplitude of HBP limits its application in all pacing candidates, especially in infra‐Hisian block cases.…”

“…Nowadays, HPCSP has been widely adopted from inside and outside the field 5 . Recent studies have also demonstrated that HPCSP significantly improved heart function in heart failure patients with left bundle branch block (LBBB), 6–8 and even better than BVP 9,10 . Theoretically, HBP is the most physiological pacing mode and it could achieve the same narrow QRS complex as the intrinsic and correct LBBB or right bundle branch block (RBBB) as well.…”

Reverse left ventricular remodeling with left bundle branch area pacing in heart failure patients with dyssynchrony: Systematic Review and Meta-Analysis

“…The remaining 20 studies were later excluded due to lack of a target population or failure to report outcomes of interest. As a result, the final analysis included 15 observational cohort studies [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] with 772 individuals with HFrEF who underwent LBBAP implantation. The included articles were classified into 2 categories: patients with PICM (4 articles, 62 patients) [7][8][9][10] and patients without PICM (11 articles, 710 patients) [11][12][13][14][15][16][17][18][19][20][21] .…”

“…Thus, the benefits of LBBAP, such as improvement in clinical and echocardiographic findings and fewer complications, have gained interest as a potential alternative to BVP [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . However, the data to support these notions remain controversial.…”

Left bundle branch pacing in a ventricular pacing dependent patient with heart failure: A case report

“…Subsequently, a number of studies have shown that in heart failure with LBBB, LBBP-related complications and adverse clinical outcomes, including heart failure hospitalization and mortality, were not significantly different compared to CRT[ 16 ]. Therefore, LBBP could be a superior alternative to CRT in patients with typical LBBB.…”