Left Bundle Branch Area Pacing Versus Biventricular Pacing as Initial Strategy for Cardiac Resynchronization

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Left bundle branch area pacing (LBBAP) offers an alternative pacing strategy for cardiac resynchronization therapy (CRT) compared to traditional biventricular pacing (BiVp).
• Evaluating the comparative outcomes of LBBAP and BiVp as initial CRT strategies is crucial for optimizing patient care.

Purpose of the Study:

• To compare the efficacy and safety of LBBAP versus BiVp when used as the initial implantation strategy for CRT.
• To assess differences in clinical outcomes, procedural metrics, and device performance between the two pacing methods.

Main Methods:

• A prospective, multicenter, observational, nonrandomized study included first-time CRT recipients undergoing either LBBAP or BiVp.
• Primary efficacy endpoint: composite of heart failure (HF)-related hospitalization and all-cause mortality.
• Primary safety endpoints: acute and long-term complications; secondary outcomes included functional class and electro/echocardiographic parameters.

Main Results:

• The LBBAP group showed a significantly lower rate of the primary efficacy outcome (24.2% vs. 42.4%, P=0.021), primarily driven by reduced HF hospitalizations (22.6% vs. 39.5%, P=0.021).
• No significant differences were observed in all-cause mortality or long-term complications between LBBAP and BiVp groups.
• LBBAP was associated with shorter procedural and fluoroscopy times, reduced QRS duration, and improved left ventricular ejection fraction compared to BiVp.

Conclusions:

• LBBAP as an initial CRT strategy demonstrates a reduced risk of HF-related hospitalizations compared to BiVp.
• LBBAP offers advantages including shorter procedure/fluoroscopy times, narrower paced QRS duration, and enhanced left ventricular ejection fraction post-implantation.