Clinical outcomes of conduction system pacing compared to biventricular pacing in patients requiring cardiac resynchronization therapy

Vijayaraman, Pugazhendhi; Zalavadia, Dipen; Haseeb, Abdul; Dye, Cicely; Madan, Nidhi; Skeete, Jamario; Vipparthy, Sharath C; Young, W. Glenn; Ravi, Venkatesh; Rajakumar, Clement; Pokharel, Parash; Larsen, Timothy R.; Huang, Henry; Storm, Randle; Oren, Jess W.; Batul, Syeda Atiqa; Trohman, Richard G.; Subzposh, Faiz A.; Sharma, Parikshit S.

doi:10.1016/j.hrthm.2022.04.023

Cited by 89 publications

(72 citation statements)

References 25 publications

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“…The success rate of LBBP in the cohort was 100% with stable pacing capture threshold and R-wave amplitude at the end of 12 months follow-up 23 . Another study that compared CSP (87 HBP and 171 LBBP) and BVP also noted a significantly narrower QRSd, greater LVEF improvement, and lower composite of HFH and mortality 31 .…”

Section: Discussionmentioning

confidence: 92%

Left bundle branch area pacing for heart failure patients requiring cardiac resynchronization therapy: a meta-analysis

Jin

Dai

et al. 2023

Preprint

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Background: Left bundle area branch pacing (LBBP) is a novel conduction system pacing method to achieve effective physiological pacing and an alternative to cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) for patients with heart failure and reduced ejection fraction (HFrEF). Objective: To review current data comparing BVP and LBBP in patients with HFrEF and indication CRT. Methods: We searched PubMed/Medline, Web of Science, and Cochrane Library from the inception of the database to November 2022. All studies that compared LBBP with BVP in patients with HFrEF and indications of CRT were included. Two reviewers performed the study selection, data abstraction, and risk of bias assessment. We calculated risk ratios with the Mantel-Haenszel method and mean difference with inverse variance using random effect models. We assessed heterogeneity using the I index, with I > 50% indicating significant heterogeneity. Results: Ten studies (9 observational studies and 1 randomized controlled trial; 616 patients; 15 centers) published between 2020 and 2022 were included. We observed a shorter fluoroscopy time [mean difference (MD) 9.68, 95% CI 4.49-14.87, I =95%, P<0.01, minutes] as well as a shorter procedure time (MD 33.68, 95% CI 17.80-49.55, I =73%, P<0.01, minutes) during implantation of LBBP CRT compared to conventional BVP CRT. LBBP was shown to have a greater reduction in QRSd (MD 25.13, 95%CI 20.06-30.20, I = 51%, P<0.01, milliseconds) a greater left ventricular ejection fraction (LVEF) improvement (MD 5.80, 95% CI 4.81-6.78, I =0%, P<0.01, percentage) and a greater ventricular end-diastolic diameter (LVEDD) reduction (MD 2.11, 95% CI 0.12-4.10, I =18%, P=0.04, millimeter). There was a greater improvement in New York Heart Association function (NYHA) class with LBBP (MD 0.37, 95% CI 0.05-0.68, I =61%, P=0.02).LBBP was also associated with a lower risk of a composite of heart failure hospitalizations and all-cause mortality [Risk ratio (RR) 0.48, 95% CI 0.25-0.90, I =0%, p=0.02] driven by reduced heart failure hospitalizations (RR 0.39, 95% CI 0.19-0.82, I =0%, p=0.01). However, all-cause mortality rates were low in both groups (1.52% vs. 1.13%) and similar (RR 0.98, 95%CI 0.21-4.68, I =0%, p=0.87). Conclusion: Compared to BVP, LBBP is associated with, a greater improvement in LV systolic function, and a lower rate of heart failure-related hospitalization. Dedicated randomized controlled trials and larger patient populations are needed to further elucidate the long-term safety and efficacy of LBBP CRT.

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Section: Discussionmentioning

confidence: 92%

Left bundle branch area pacing for heart failure patients requiring cardiac resynchronization therapy: a meta-analysis

Jin

Dai

et al. 2023

Preprint

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“…These categories are in accordance with the recent approach in resynchronization therapy using the His bundle pacing or the left bundle pacing in patients with “true” LBBB. Several studies show improved clinical outcomes compared to biventricular pacing [ 80 , 81 ]. However, according to the results of the systematic review, their benefit needs to be verified by randomized controlled studies [ 82 ].…”

Section: Discussionmentioning

confidence: 99%

The Primary Alteration of Ventricular Myocardium Conduction: The Significant Determinant of Left Bundle Branch Block Pattern

Bachárová

Bayés-de-Luna

2022

Cardiology Research and Practice

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Intraventricular conduction disturbances (IVCD) are currently generally accepted as ECG diagnostic categories. They are characterized by defined QRS complex patterns that reflect the abnormalities in the intraventricular sequence of activation that can be caused by pathology in the His-Purkinje conduction system (HP) or ventricular myocardium. However, the current understanding of the IVCD’s underlying mechanism is mostly attributed to HP structural or functional alterations. The involvement of the working ventricular myocardium is only marginally mentioned or not considered. This opinion paper is focused on the alterations of the ventricular working myocardium leading to the most frequent IVCD pattern—the left bundle branch block pattern (LBBB). Recognizing the underlying mechanisms of the LBBB patterns and the involvement of the ventricular working myocardium is of utmost clinical importance, considering a patient’s prognosis and indication for cardiac resynchronization therapy.

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“…Conduction system pacing by means of His bundle pacing or left bundle pacing has already remarkably affected the field of ventricular pacing and will do so even more so in the upcoming years. Given the advantages of conduction system pacing such as a shorter QRS width, more favourable LV remodelling compared to CRT [ 26 , 27 ] will likely make this the preferred approach in patients undergoing pace and ablate in the future [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Sex-Related Differences in Patient Selection for and Outcomes after Pace and Ablate for Refractory Atrial Fibrillation: Insights from a Large Multicenter Cohort

Baumgärtner

Kaelin-Friedrich

Makowski

et al. 2022

JCM

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Background: A pace and ablate strategy may be performed in refractory atrial fibrillation with rapid ventricular response. Objective: We aimed to assess sex-related differences in patient selection and clinical outcomes after pace and ablate. Methods: In a retrospective multicentre study, patients undergoing AV junction ablation were studied. Sex-related differences in baseline characteristics, all-cause mortality, heart failure (HF) hospitalizations, and device-related complications were assessed. Results: Overall, 513 patients underwent AV junction ablation (median age 75 years, 50% men). At baseline, men were younger (72 vs. 78 years, p < 0.001), more frequently had non-paroxysmal AF (82% vs. 72%, p = 0.006), had a lower LVEF (35% vs. 55%, p < 0.001) and more frequently had cardiac resynchronization therapy (75% vs. 25%, p < 0.001). Interventional complications were rare in both groups (1.2% vs. 1.6%, p = 0.72). Patients were followed for a median of 42 months in survivors (IQR 22–62). After 4 years of follow-up, the combined endpoint of all-cause death or HF hospitalization occurred more often in men (38% vs. 27%, p = 0.008). The same was observed for HF hospitalizations (22% vs. 11%, p = 0.021) and all-cause death (28% vs. 21%, p = 0.017). Sex category remained an independent predictor of death or HF hospitalization after adjustment for age, LVEF and type of stimulation. Lead-related complications, infections, and upgrade to ICD or CRT occurred in 2.1%, 0.2% and 3.5% of patients, respectively. Conclusions: Pace and ablate is safe with a need for subsequent device-related re-interventions in 5.8% over 4 years. We found significant sex-related differences in patient selection, and women had a more favourable clinical course after AV junction ablation.

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Clinical outcomes of conduction system pacing compared to biventricular pacing in patients requiring cardiac resynchronization therapy

Cited by 89 publications

References 25 publications

Left bundle branch area pacing for heart failure patients requiring cardiac resynchronization therapy: a meta-analysis

Left bundle branch area pacing for heart failure patients requiring cardiac resynchronization therapy: a meta-analysis

The Primary Alteration of Ventricular Myocardium Conduction: The Significant Determinant of Left Bundle Branch Block Pattern

Sex-Related Differences in Patient Selection for and Outcomes after Pace and Ablate for Refractory Atrial Fibrillation: Insights from a Large Multicenter Cohort

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