Cardiac resynchronization therapy via left bundle branch pacing vs. optimized biventricular pacing with adaptive...

Area of Science:

• Cardiology
• Electrophysiology
• Heart Failure Management

Background:

• Heart failure with reduced left ventricular ejection fraction (HFrEF) and left bundle branch block (LBBB) presents challenges for cardiac resynchronization therapy (CRT).
• Optimized biventricular pacing (BVP-aCRT) is a standard CRT approach.
• Left bundle branch area pacing (LBBP) is an alternative pacing strategy.

Purpose of the Study:

• To evaluate the feasibility and efficacy of LBBP-CRT compared to BVP-aCRT in patients with HFrEF and LBBB.
• To assess differences in QRS duration, left ventricular ejection fraction (LVEF), and response rates between the two CRT methods.

Main Methods:

• A prospective, non-randomized study enrolled 100 patients with HFrEF and LBBB undergoing CRT.
• Patients were divided into LBBP-CRT (n=49) and BVP-aCRT (n=51) groups.
• Implant characteristics and echocardiographic parameters were assessed at baseline, 6 months, and 1 year.

Main Results:

• LBBP-CRT showed a higher success rate (98.00%) than BVP-aCRT (91.07%).
• LBBP-CRT achieved significantly greater QRS duration reduction, higher absolute LVEF, and improved △LVEF at both 6-month and 1-year follow-ups.
• A higher super-response rate was observed in the LBBP-CRT group at 6 and 12 months.
• Lower pacing thresholds were noted in the LBBP-CRT group throughout follow-up.

Conclusions:

• LBBP-CRT is a feasible and effective alternative to BVP-aCRT for patients with HFrEF and LBBB.
• LBBP-CRT demonstrates superior electromechanical resynchronization, leading to better clinical and echocardiographic outcomes, including a higher super-response rate.
• No significant differences in complications or adverse clinical outcomes were observed between the groups.