Left Bundle Branch Area Pacing versus Biventricular Pacing for Cardiac Resynchronization Therapy on Morbidity and
Yixiu Liang1, Zilong Xiao1, Xi Liu1,2
1Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China.
Insights
Left bundle branch area pacing (LBBAP) offers comparable outcomes to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT). This study found no significant difference in major adverse events between LBBAP and BVP in CRT patients.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Left bundle branch area pacing (LBBAP) is an emerging alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT).
- CRT aims to improve heart function in patients with heart failure and conduction abnormalities.
Purpose of the Study:
- To compare the morbidity and mortality rates between LBBAP and BVP in patients undergoing CRT.
- To evaluate the safety and efficacy of LBBAP as a CRT strategy.
Main Methods:
- Retrospective analysis of 491 patients receiving CRT at two high-volume centers.
- Primary endpoint: composite of all-cause death and heart failure hospitalization.
- Secondary endpoint: all-cause death. Analysis included multivariate Cox regression and propensity score matching.
Main Results:
- No significant difference in the primary endpoint (composite of death/hospitalization) between LBBAP (13.6%) and BVP (22.0%) groups (HR 0.70, P=0.15).
- No significant difference in the secondary endpoint (all-cause death) between LBBAP (6.5%) and BVP (9.2%) groups (HR 0.91, P=0.79).
- Multivariate and propensity score analyses confirmed comparable outcomes for both pacing methods.
Conclusions:
- Left bundle branch area pacing demonstrates comparable efficacy to biventricular pacing regarding morbidity and mortality in CRT patients.
- LBBAP is a viable alternative to BVP for achieving cardiac resynchronization.
Background:
Left bundle branch area pacing (LBBAP) has emerged as an alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT). We aimed to compare the morbidity and mortality associated with LBBAP versus BVP in patients undergoing CRT implantation.
Methods:
Consecutive patients who received CRT from two high-volume implantation centers were retrospectively recruited. The primary endpoint was a composite of all-cause death and heart failure hospitalization, and the secondary endpoint was all-cause death.
Results:
A total of 491 patients receiving CRT (154 via LBBAP and 337 via BVP) were included, with a median follow-up of 31 months. The primary endpoint was reached by 21 (13.6%) patients in the LBBAP group, as compared with 74 (22.0%) patients in the BVP group [hazard ratio (HR) 0.70, 95% confidence interval (CI) 0.43-1.14, P = 0.15]. There were 10 (6.5%) deaths in the LBBAP group, as compared with 31 (9.2%) in the BVP group (HR 0.91, 95% CI 0.44-1.86, P = 0.79). No significant difference was observed in the risk of either the primary or secondary endpoint between LBBAP and BVP after multivariate Cox regression (HR 0.74, 95% CI 0.45-1.23, P = 0.24, and HR 0.77, 95% CI 0.36-1.67, P = 0.51, respectively) or propensity score matching (HR 0.72, 95% CI 0.41-1.29, P = 0.28, and HR 0.69, 95% CI 0.29-1.65, P = 0.40, respectively).
Conclusion:
LBBAP was associated with a comparable effect on morbidity and mortality relative to BVP in patients with indications for CRT.
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