New-Onset Atrial Fibrillation in Left Bundle Branch Area Pacing Compared With Right Ventricular Pacing

Ravi, Venkatesh; Sharma, Parikshit S.; Patel, Neil; Dommaraju, Sujithraj; Zalavadia, Dipen; Garg, Varun; Larsen, Timothy R.; Naperkowski, Angela; Wasserlauf, Jeremiah; Krishnan, K. Ranga Rama; Young, W. Glenn; Pokharel, Parash; Oren, Jess W.; Storm, Randle; Trohman, Richard G.; Huang, Henry D.; Subzposh, Faiz A.; Vijayaraman, Pugazhendhi

doi:10.1161/circep.121.010710

Cited by 15 publications

(26 citation statements)

References 6 publications

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“…A retrospective cohort study reported a lower incidence of new-onset AF in patients with LBBAP than that of RVP (5.2 vs. 18.1%). 17 Our prospective observational study confirmed the beneficial effect of LBBAP on new-onset AF in a relatively larger sample size (total of 527 patients, and 257 patients with LBBAP). The positive interaction between pacing modalities and ventricular pacing burden validated the more pronounced beneficial effect of LBBAP in patients with VP > 20%.…”

Section: Discussionsupporting

confidence: 72%

New-onset atrial fibrillation following left bundle branch area pacing vs. right ventricular pacing: a two-centre prospective cohort study

Zhu

Wang

et al. 2022

EP Europace

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Aims To investigate whether left bundle branch area pacing (LBBAP) can reduce the risk of new-onset atrial fibrillation (AF) compared with right ventricular pacing (RVP). Methods and results Patients with indications for dual-chamber pacemaker implant and no history of AF were prospectively enrolled if they underwent successful LBBAP or RVP. The primary endpoint was time to the first occurrence of AF detected by pacemaker programming or surface electrocardiogram. Follow-up at clinic visit was performed and multivariate Cox regression models were applied to evaluate the effect of LBBAP on new-onset AF. The final analysis included 527 patients (mean age 65.3 ± 12.6, male 47.3%), with 257 in the LBBAP and 270 in the RVP groups. During a mean follow-up of 11.1 months, LBBAP resulted in significantly lower incidence of new-onset AF (7.4 vs. 17.0%, P < 0.001) and AF burden (3.7 ± 1.9 vs. 9.3 ± 2.2%, P < 0.001) than RVP. After adjusting for confounding factors, LBBAP demonstrated a lower hazard ratio for new-onset AF compared with RVP {hazard ratio (HR) [95% confidence interval (CI)]: 0.278 (0.156, 0.496), P < 0.001}. A significant interaction existed between pacing modalities and the percentage of ventricular pacing (VP%) (P for interaction = 0.020). In patients with VP ≥ 20%, LBBAP was associated with decreased risk of new-onset AF compared with RVP [HR (95% CI): 0.199 (0.105, 0.378), P < 0.001]. The effect of pacing modalities was not pronounced in patients with VP < 20% [HR (95% CI): 0.751 (0.309, 1.823), P = 0.316]. Conclusion Left bundle branch area pacing demonstrated a reduced risk of new-onset AF compared with RVP. Patients with a high ventricular pacing burden might benefit from LBBAP.

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Section: Discussionsupporting

confidence: 72%

New-onset atrial fibrillation following left bundle branch area pacing vs. right ventricular pacing: a two-centre prospective cohort study

Zhu

Wang

et al. 2022

EP Europace

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“…An observational study by Ravi et al 42 reported on 410 patients with pacemakers (173 with LBBAP and 237 with right ventricular pacing) followed for 600±278 days. A new diagnosis of AF ≥30 s was noted in 5% patients in the LBBAP group and 18% patients in the right ventricular pacing group.…”

Section: Discussionmentioning

confidence: 99%

Arrhythmic Risk in Biventricular Pacing Compared With Left Bundle Branch Area Pacing: Results From the I-CLAS Study

Herweg,

Sharma,

Cano

et al. 2024

Circulation

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Background: Left bundle branch area pacing (LBBAP) may be associated with greater improvement in left ventricular ejection fraction and reduction in death or heart failure hospitalization when compared with biventricular pacing (BVP) in patients requiring cardiac resynchronization therapy (CRT). We sought to compare the occurrence of sustained ventricular tachycardia or ventricular fibrillation (VT/VF) and new onset atrial fibrillation (AF) in patients undergoing BVP and LBBAP. Methods: This International Collaborative LBBAP Study (I-CLAS) included patients with LVEF≤35% who underwent BVP or LBBAP for CRT between Jan 2018 to June 2022 at 15 centers. We performed propensity score matched (PS) analysis of LBBAP and BVP in a 1:1 ratio. We assessed the incidence of VT/VF and new-onset AF among patients with no prior history of AF. Time to sustained VT/VF and time to new-onset AF was analyzed using Cox proportional hazards survival model. Results: Among 1778 patients undergoing CRT (981-BVP, 797-LBBAP), PS matched 1414 patients (PS-BVP:707, PS-LBBAP:707). The occurrence of VT/VF was significantly lower with LBBAP compared with BVP (4.2% vs 9.3%;HR 0.46;95%CI 0.29-0.74;p<0.001). The incidence of VT storm (>3 episodes in 24 hours) was also significantly lower with LBBAP compared with BVP (0.8% vs 2.5%;p=0.013). Among 299 patients with CRT-pacemakers (BVP-111, LBBAP-188), VT/VF occurred in 8 patients in the BVP group vs. none in the LBBAP group (7.2% vs 0%;p<0.001). In 1194 patients with no prior history of VT/VF or antiarrhythmic therapy (BVP-591, LBBAP-603), the occurrence of VT/VF was significantly lower with LBBAP compared with BVP (3.2% vs 7.3%;HR 0.46;95%CI 0.26-0.81;p=0.007). Among patients with no prior history of AF (n=890), the occurrence of new-onset AF >30 seconds was significantly lower with LBBAP compared with BVP (2.8% vs 6.6%;HR 0.34;95%CI 0.16-0.73;p=0.008). The incidence of AF lasting >24 hours was also significantly lower with LBBAP compared with BVP (0.7% vs 2.9%;p=0.015). Conclusions: LBBAP was associated with lower incidence of sustained VT/VF and new-onset AF compared with BVP. This difference remained significant after adjustment for differences in baseline characteristics between patients with BVP and LBBAP. Physiologic resynchronization by LBBAP may be associated with lower risk of arrhythmias compared with BVP.

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“…In an observational registry 52 60 also suggests that LBBAP reduces the incidence of AF when compared to RVP.…”

Section: Lbbap Vs Rvpmentioning

confidence: 99%

“…Furthermore, when compared to traditional CRT, early and mid-term echocardiographic and functional outcomes are favorable for LBBAP. 59 A recent retrospective analysis 60 2. The detrimental effects of chronic RVP have been well detailed since the publication of the Dual Chamber and VVI Implantable Defibrillator (DAVID) trial and others.…”

Section: Recommendation-specific Supportive Textmentioning

confidence: 99%

2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure

Chung

Patton

Lau³

et al. 2023

Journal of Arrhythmia

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Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing‐induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre‐procedure evaluation and preparation, implant procedure management, follow‐up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.

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New-Onset Atrial Fibrillation in Left Bundle Branch Area Pacing Compared With Right Ventricular Pacing

Cited by 15 publications

References 6 publications

New-onset atrial fibrillation following left bundle branch area pacing vs. right ventricular pacing: a two-centre prospective cohort study

New-onset atrial fibrillation following left bundle branch area pacing vs. right ventricular pacing: a two-centre prospective cohort study

Arrhythmic Risk in Biventricular Pacing Compared With Left Bundle Branch Area Pacing: Results From the I-CLAS Study

2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure

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