Feasibility and safety of left bundle branch area pacing—cardiac resynchronization therapy in elderly patients

Grieco, Domenico; Bressi, Edoardo; Sedláček, Kamil; Čurila, Karol; Vernooy, Kevin; Fedele, Elisa; Ruvo, Ermenegildo De; Fagagnini, Alessandro; Kron, Jordana; Padala, Santosh K.; Ellenbogen, Kenneth A.; Calò, Leonardo

doi:10.1007/s10840-022-01174-4

Cited by 11 publications

(18 citation statements)

References 36 publications

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“…The systematic search identified 37 eligible publications, 4–8,18–49 including 20 comparative studies—among which four were randomized controlled trials—and 17 single‐arm investigations reporting outcomes in patients undergoing CSP for CRT (details shown in Figure 1). The comparative studies enabled network meta‐analyses of the three interventions—His‐CRT, LBB‐CRT, and BiV‐CRT.…”

Section: Resultsmentioning

confidence: 99%

“…LVEF measurements before and after CSP were reported in 32 studies (2145 patients), 4–8,18–26,28–35,37–39,41,42,44,45,47–49 showing an overall mean LVEF improvement of +15.4% (95% CI: [13.3–17.5]; I 2 = 95%; Supporting Information: Figure ). LVEF changes were compared between CSP and BVP in 18 studies 4,5,7,8,20–22,24,25,31,33,37–39,41,42,44,49 .…”

Section: Resultsmentioning

confidence: 99%

“…Measurements of LVESV were reported in 14 studies 4–8,18,22–24,35,36,38,39,49 (601 patients), which reported an overall mean reduction in LVESV of −54.6 mL (95% CI: [−68.7 to −40.4]; I 2 = 95%; Supporting Information: Figure ). Reductions in LVESV with CSP were compared to BVP in nine studies 4,5,7,8,22,24,38,39,49 .…”

Section: Resultsmentioning

confidence: 99%

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Effectiveness of conduction system pacing for cardiac resynchronization therapy: A systematic review and network meta‐analysis

Tavolinejad,

Kazemian,

Bozorgi

et al. 2023

Cardiovasc electrophysiol

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IntroductionCardiac resynchronization therapy (CRT) with biventricular pacing (BiV‐CRT) is ineffective in approximately one‐third of patients. CRT with Conduction system pacing (CSP‐CRT) may achieve greater synchronization. We aimed to assess the effectiveness of CRT with His pacing (His‐CRT) or left bundle branch pacing (LBB‐CRT) in lieu of biventricular CRT.Methods and ResultsThe PubMed, Embase, Web of Science, Scopus, and the Cochrane Library were systematically searched until August 19, 2023, for original studies including patients with reduced left ventricular ejection fraction (LVEF) who received His‐ or LBB‐CRT, that reported either CSP‐CRT success, LVEF, QRS duration (QRSd), or New York Heart Association (NYHA) classification. Effect measures were compared with frequentist network meta‐analysis. Thirty‐seven publications, including 20 comparative studies, were included. Success rates were 73.5% (95% CI: 61.2–83.0) for His‐CRT and 91.5% (95% CI: 88.0–94.1) for LBB‐CRT. Compared to BiV‐CRT, greater improvements were observed for LVEF (mean difference [MD] for His‐CRT +3.4%; 95% CI [1.0; 5.7], and LBB‐CRT: +4.4%; [2.5; 6.2]), LV end‐systolic volume (His‐CRT:17.2mL [29.7; 4.8]; LBB‐CRT:15.3mL [28.3; 2.2]), QRSd (His‐CRT: –17.1ms [–25.0; –9.2]; LBB‐CRT: –17.4ms [–23.2; –11.6]), and NYHA (Standardized MD [SMD]: His‐CRT:0.4 [0.8; 0.1]; LBB‐CRT:0.4 [–0.7; –0.2]). Pacing thresholds at baseline and follow‐up were significantly lower with LBB‐CRT versus both His‐CRT and BiV‐CRT. CSP‐CRT was associated with reduced mortality (R = 0.75 [0.61–0.91]) and hospitalizations risk (RR = 0.63 [0.42–0.96]).ConclusionThis study found that CSP‐CRT is associated with greater improvements in QRSd, echocardiographic, and clinical response. LBB‐CRT was associated with lower pacing thresholds. Future randomized trials are needed to determine CSP‐CRT efficacy.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Effectiveness of conduction system pacing for cardiac resynchronization therapy: A systematic review and network meta‐analysis

Tavolinejad,

Kazemian,

Bozorgi

et al. 2023

Cardiovasc electrophysiol

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“…The initial results of prospective observational studies on LBBAP are encouraging, with LBBAP lead implantation success ranging from 80% to 97%, and tremendous expectations are reposted in LBBAP for achieving resynchronization therapy in patients with HF and LBBB (Huang et al, 2020;Heckman et al, 2021;Jastrzębski et al, 2022a;Grieco et al, 2022). A seminal study by Huang and colleagues reported a high LBBAP success rate (97%) as a first-line strategy among 63 patients with LBBB and non-ischemic cardiomyopathy (Huang et al, 2020).…”

Section: Lbbap For Crt In Lbbbmentioning

confidence: 99%

Conduction system pacing for cardiac resynchronization therapy: State of the art, current controversies, and future perspectives

et al. 2023

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Biventricular pacing (BVP) is the established treatment to perform cardiac resynchronization therapy (CRT) in patients with heart failure (HF) and left bundle branch block (LBBB). However, BVP is an unnatural pacing modality still conditioned by the high percentage of non-responders and coronary sinus anatomy. Conduction system pacing (CSP)—His bundle pacing (HBP) and Left bundle branch area pacing (LBBAP)- upcomes as the physiological alternative to BVP in the quest for the optimal CRT. CSP showed promising results in terms of better electro-mechanical ventricular synchronization compared to BVP. However, only a few randomized control trials are currently available, and technical challenges, along with the lack of information on long-term clinical outcomes, limit the establishment of a primary role for CSP over conventional BVP in CRT candidates. This review provides a comprehensive literature revision of potential applications of CSP for CRT in diverse clinical scenarios, underlining the current controversies and prospects of this technique.

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“…Grieco et al evaluated the feasibility and safety of LBBP-CRT in elderly patients. The study compared electrical parameters, echocardiographic parameters, lead parameters, and complications, revealing that LBBP achieved comparable efficacy between elderly patients and younger patients with narrow QRS, satisfactory pacing threshold, impedance and sensing, low rates of complication, and improved LVEF (33). In summary, LBBP is a promising option for delivering CRT in HF patients, providing excellent ventricular resynchronization, improved cardiac function, and great clinical benefits with a high success rate, low and stable pacing thresholds, and fewer complications.…”

Section: Benefits Of Left Bundle Branch Pacing In Heart Failure Patie...mentioning

confidence: 99%

Left bundle branch area pacing: A promising modality for cardiac resynchronization therapy

Liu

Jin

et al. 2022

Front. Cardiovasc. Med.

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Cardiac resynchronization therapy (CRT) is recognized as the first-line management for patients with heart failure (HF) and conduction disorders. As a conventional mode for delivering CRT, biventricular pacing (BVP) improves cardiac function and reduces HF hospitalizations and mortality, but there are still limitations given the high incidence of a lack of response rates. Alternative pacing methods are needed either for primary or rescue therapy. In recent years, conduction system pacing (CSP) has emerged as a more physiological pacing modality for simultaneous stimulation of the ventricles, including His bundle pacing (HBP) and left bundle branch pacing (LBBP). CSP activates the His-Purkinje system, allowing normal ventricular stimulation. However, HBP is technically challenging with a relatively low success rate, high pacing threshold, and failure to correct distal conduction abnormalities. Therefore, LBBP stands out as a novel ideal physiological pacing modality for CRT. Several non-randomized studies compared the feasibility and safety of LBBP with BVP and concluded that LBBP is superior to BVP for delivering CRT with a narrower QRS and greater improvements in left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) functional class. Concurrently, some studies showed lower and stable pacing thresholds and greater improvement of B-type natriuretic peptide (BNP) levels, as well as better mechanical synchronization and efficiency. LBBP ensures better ventricular electromechanical resynchronization than BVP. In this review, we discuss current knowledge of LBBP, compare LBBP with BVP, and explore the potential of LBBP to serve as an alternative primary therapy to realize cardiac resynchronization.

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Feasibility and safety of left bundle branch area pacing—cardiac resynchronization therapy in elderly patients

Cited by 11 publications

References 36 publications

Effectiveness of conduction system pacing for cardiac resynchronization therapy: A systematic review and network meta‐analysis

Effectiveness of conduction system pacing for cardiac resynchronization therapy: A systematic review and network meta‐analysis

Conduction system pacing for cardiac resynchronization therapy: State of the art, current controversies, and future perspectives

Left bundle branch area pacing: A promising modality for cardiac resynchronization therapy

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