Comparison of Pacing Performance and Clinical Outcomes Between Left Bundle Branch and His Bundle Pacing
Eugene S J Tan1, Rodney Soh2, Elaine Boey3
1Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore.
Insights
Left bundle branch pacing (LBBP) offers superior pacing performance and reliability compared to His-bundle pacing (HBP). LBBP is recommended as the preferred first-line conduction system pacing modality due to improved outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Left bundle branch pacing (LBBP) and His-bundle pacing (HBP) are methods for physiological ventricular activation.
- Conduction system pacing (CSP) aims to mimic natural cardiac electrical conduction.
Purpose of the Study:
- To compare the feasibility, device performance, and clinical outcomes of LBBP versus HBP.
- To determine the preferred first-line CSP modality.
Main Methods:
- Prospective study of 282 patients undergoing successful CSP (119 HBP, 163 LBBP) from 2018-2021.
- Primary endpoint: optimal device performance (pacing thresholds <2.5 V, R-wave amplitude ≥5 V, no CSP complications).
- Secondary endpoint: composite of heart failure hospitalizations or all-cause mortality.
Main Results:
- No significant differences in success rates or complications between LBBP and HBP.
- LBBP showed significantly better pacing performance (lower thresholds, higher R-wave amplitudes) and was associated with 9-fold increased odds of optimal device performance.
- LBBP demonstrated a lower incidence of increased pacing thresholds and a trend towards improved event-free survival compared to HBP.
Conclusions:
- LBBP and HBP have similar feasibility and safety.
- LBBP offers superior pacing performance and reliability, with trends towards improved survival.
- LBBP should be the preferred first-line conduction system pacing modality.
Background:
Left bundle branch (LBBP) and His-bundle pacing (HBP) provide physiological ventricular activation.
Objectives:
This study investigated differences in feasibility, device performance, and clinical outcomes between LBBP and HBP.
Methods:
Consecutive patients with LBBP and HBP from 2018 to 2021 in 2 centers were prospectively studied. The primary endpoint was optimal device performance during follow-up, defined as the presence of pacing thresholds <2.5 V, R-wave amplitude ≥5 V, and absence of conduction system pacing (CSP)-related complications. The secondary endpoint was the composite of heart failure hospitalizations or all-cause mortality.
Results:
Among 338 patients, 282 underwent successful CSP (119 HBP, 163 LBBP). Success rates, CSP-related complications, and need for reoperations did not differ between LBBP and HBP (P > 0.05). Pacing thresholds were lower, whereas R-wave amplitudes and lead impedance were higher in LBBP (P < 0.05). The primary endpoint was more frequent in LBBP than HBP (79% vs 34%; P < 0.001), with LBBP independently associated with 9-fold increased odds of optimal device performance (adjusted OR: 9.31; 95% CI: 5.14-16.86). LBBP was less likely to have increased pacing thresholds by >1 V (1% vs 19% HBP, P < 0.001). The secondary outcome was less frequent in LBBP than HBP (9% vs 24%, P = 0.001), with LBBP trending towards higher event-free survival (HR: 0.62; 95% CI: 0.31-1.23). The secondary outcome was independent of pacing burden or pacing indication.
Conclusions:
Despite similar feasibility and safety profiles, LBBP confers additional benefits in pacing performance and reliability, shows trends towards improved survival compared to HBP, and should be the preferred first-line CSP modality of choice.
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