Sex Differences in Left Bundle Branch Area Pacing Versus Biventricular Pacing for Cardiac Resynchronization Therapy
Usha B Tedrow1, Andres F Miranda-Arboleda1, William H Sauer1
1Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
JACC. Clinical Electrophysiology
|June 6, 2024
Summary
Men and women show similar outcomes with left bundle branch area pacing (LBBAP) for cardiac resynchronization therapy (CRT). LBBAP benefits men more than biventricular pacing (BIVP), reducing heart failure hospitalizations and mortality.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Women generally respond better to biventricular pacing (BIVP) than men.
- Sex-based differences in conduction exist in BIVP.
- Left bundle branch area pacing (LBBAP) offers direct conduction system capture.
Purpose of the Study:
- To compare sex differences in response to LBBAP versus BIVP for initial cardiac resynchronization therapy (CRT).
Main Methods:
- A multicenter prospective registry included patients with reduced ejection fraction and conduction abnormalities.
- Patients received either LBBAP or BIVP as initial CRT.
- The primary outcome was heart failure hospitalization or all-cause mortality; safety assessed procedure-related complications.
Main Results:
- No significant sex difference in primary outcome for LBBAP.
- Women had fewer primary outcomes with BIVP compared to men receiving BIVP (P=0.03).
- Men showed a lower primary outcome rate with LBBAP (29.9%) versus BIVP (46.5%) (P=0.004).
- Women showed no significant difference in primary outcomes between LBBAP (24.14%) and BIVP (36.2%) (P=0.23).
- Complication rates were similar across all groups.
Conclusions:
- LBBAP and BIVP yield similar clinical outcomes for men and women undergoing CRT.
- LBBAP significantly reduces heart failure hospitalizations and mortality in men compared to BIVP.
- No significant difference in outcomes between LBBAP and BIVP was observed in women.
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