Clinical outcomes of left bundle branch area pacing compared to His bundle pacing
Pugazhendhi Vijayaraman1,2, Clement Rajakumar2, Angela M Naperkowski1
1Geisinger Wyoming Valley Medical Center, Geisinger Heart Institute, Wilkes Barre, Pennsylvania, USA.
Insights
Left bundle branch area pacing (LBBAP) showed similar clinical outcomes, including death and heart failure hospitalization (HFH), compared to His bundle pacing (HBP) in patients receiving permanent pacemakers.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- His bundle pacing (HBP) is recognized as the most physiologic pacing method, linked to reduced heart failure hospitalization (HFH) and mortality.
- Left bundle branch area pacing (LBBAP) presents a viable alternative for ventricular pacing, offering a potentially more physiological approach.
Purpose of the Study:
- To compare the clinical outcomes between LBBAP and HBP in a large cohort of patients undergoing permanent pacemaker implantation.
- To evaluate the safety and efficacy of LBBAP as an alternative to HBP.
Main Methods:
- An observational registry study included 359 patients with AV block/AV node ablation who received de novo permanent pacemakers with successful LBBAP or HBP.
- The primary outcome was a composite of all-cause death or HFH. Secondary outcomes included individual components and outcomes based on ventricular pacing burden.
Main Results:
- No statistically significant differences were observed in the primary composite outcome (LBBAP: 17.3% vs. HBP: 24.5%; HR: 1.15).
- Secondary outcomes, including all-cause death (LBBAP: 10% vs. HBP: 17%) and HFH (LBBAP: 10% vs. HBP: 12%), also showed no significant differences between the groups.
Conclusions:
- LBBAP demonstrated comparable clinical outcomes to HBP regarding death and HFH.
- These findings support LBBAP as a safe and effective alternative pacing strategy.
Introduction:
His bundle pacing (HBP) is the most physiologic form of pacing and has been associated with reduced risk for heart failure hospitalization (HFH) and mortality compared to right ventricular pacing. Left bundle branch area pacing (LBBAP) is a safe and effective alternative option for patients needing ventricular pacing. The aim of this study was to compare the clinical outcomes between LBBAP and HBP among a large cohort of patients undergoing permanent pacemaker implantation.
Methods:
This observational registry included consecutive patients with AV block/AV node ablation who underwent de novo permanent pacemaker implantations with successful LBBAP or HBP between April 2018 and October 2020. The primary outcome was the composite endpoint of time to death from any cause or HFH. Secondary outcomes included the composite endpoint among patients with prespecified ventricular pacing burden and individual outcomes.
Results:
The study population included 359 patients who met the inclusion criteria (163 in the HBP and 196 in the LBBAP group). Paced QRSd during LBBAP was similar to HBP (125 ± 20.2 vs. 126 ± 23.5 ms, p = .643). There were no statistically significant differences in the primary composite outcome in LBBAP (17.3%) compared to HBP (24.5%) (hazard ratio [HR]: 1.15, 95% CI: 0.72-1.82, p = .552). Secondary outcomes of death (10% vs. 17%; HR: 1.3, 95% CI: 0.73-2.33, p = .38) and HFH (10% vs. 12%; HR: 1.02, 95% CI: 0.54-1.94, p = .94) were not different among both groups.
Conclusions:
There were no statistically significant differences in the clinical outcomes of death or HFH in LBBAP when compared to HBP.
