Left bundle branch pacing vs ventricular septal pacing for cardiac resynchronization therapy
Jingjing Chen1,2, Fatima M Ezzeddine2, Xiaoke Liu3
1Department of Cardiovascular Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China.
Insights
Left ventricular septal pacing (LVSP) shows comparable outcomes to left bundle branch pacing (LBBP) in heart failure patients receiving cardiac resynchronization therapy (CRT). Deep septal pacing (DSP) was associated with increased adverse events.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Outcomes of left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) for heart failure require further investigation.
- Cardiac resynchronization therapy (CRT) aims to improve heart failure symptoms and outcomes.
Purpose of the Study:
- To compare echocardiographic and clinical outcomes of LBBP, LVSP, and deep septal pacing (DSP).
- To evaluate the efficacy and safety of different septal pacing techniques in CRT candidates.
Main Methods:
- Retrospective study of 91 patients meeting CRT criteria who underwent attempted LBBP.
- Data collection included clinical, electrocardiographic, and echocardiographic parameters at baseline and follow-up.
- Patients were categorized into LBBP (n=52), LVSP (n=25), and DSP (n=14) groups.
Main Results:
- Significant left ventricular ejection fraction (LVEF) improvement observed in LBBP and LVSP groups (P < .001).
- No significant difference in heart failure hospitalization or all-cause death between LBBP and LVSP groups.
- DSP group showed increased heart failure hospitalization and all-cause deaths compared to LBBP (HR 5.10, P=.033; HR 7.83, P=.020).
Conclusions:
- Left ventricular septal pacing (LVSP) offers comparable cardiac resynchronization therapy (CRT) outcomes to left bundle branch pacing (LBBP).
- Deep septal pacing (DSP) is associated with poorer clinical outcomes compared to LBBP.
Background:
The outcomes of left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) in patients with heart failure remain to be learned.
Objective:
The objective of this study was to assess the echocardiographic and clinical outcomes of LBBP, LVSP, and deep septal pacing (DSP).
Methods:
This retrospective study included patients who met the criteria for cardiac resynchronization therapy (CRT) and underwent attempted LBBP in 5 Mayo centers. Clinical, electrocardiographic, and echocardiographic data were collected at baseline and follow-up.
Results:
A total of 91 consecutive patients were included in the study. A total of 52 patients had LBBP, 25 had LVSP, and 14 had DSP. The median follow-up duration was 307 (interquartile range 208, 508) days. There was significant left ventricular ejection fraction (LVEF) improvement in the LBBP and LVSP groups (from 35.9 ± 8.5% to 46.9 ± 10.0%, P < .001 in the LBBP group; from 33.1 ± 7.5% to 41.8 ± 10.8%, P < .001 in the LVSP group) but not in the DSP group. A unipolar paced right bundle branch block morphology during the procedure in lead V1 was associated with higher odds of CRT response. There was no significant difference in heart failure hospitalization and all-cause deaths between the LBBP and LVSP groups. The rate of heart failure hospitalization and all-cause deaths were increased in the DSP group compared with the LBBP group (hazard ratio 5.10, 95% confidence interval 1.14-22.78, P = .033; and hazard ratio 7.83, 95% confidence interval 1.38-44.32, P = .020, respectively).
Conclusion:
In patients undergoing CRT, LVSP had comparable CRT outcomes compared with LBBP.
More Related Videos
10:17Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
06:57Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction
Published on: January 31, 2019
Related Concept Videos
01:30Pulse rhythm
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
01:13The Cardiac Cycle
The Process
Electrical signals—sent from the sinoatrial (SA) node in the right atrial wall to the atrioventricular (AV) node between the right atrium and right ventricle—cause both atria to simultaneously contract. When the signal reaches the AV node, it pauses for approximately a tenth of a second, allowing the atria to contract and...