Left bundle branch area pacing versus endocardial resynchronization in patients with heart failure
Juan Carlos Diaz1,2, Oriana Bastidas1,2, Julian Aristizabal2,3
1Division of Cardiology, Cardiac Arrhythmia and Electrophysiology Service, Clinica Las Vegas, Medellin, Colombia.
Insights
Left bundle branch area pacing (LBBAP) and endocardial cardiac resynchronization therapy (Endo-CRT) show similar heart failure outcomes. LBBAP is linked to shorter procedure times and reduced stroke risk compared to Endo-CRT.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Left bundle branch area pacing (LBBAP) and endocardial cardiac resynchronization therapy (Endo-CRT) are emerging alternatives to traditional biventricular pacing for CRT.
- These techniques aim to improve heart failure outcomes by optimizing ventricular depolarization.
Purpose of the Study:
- To compare the clinical outcomes of LBBAP versus Endo-CRT in patients with heart failure (HF) requiring CRT.
- The study utilized conventional pacing leads for both LBBAP and Endo-CRT procedures.
Main Methods:
- A comparative study included 223 patients undergoing CRT with either LBBAP (n=197) or Endo-CRT (n=26).
- Primary efficacy endpoint: composite of HF-related hospitalization and all-cause mortality. Primary safety endpoint: procedure-related complications.
- Secondary endpoints included procedural characteristics, electrocardiographic, and echocardiographic parameters.
Main Results:
- No significant difference was observed in the primary efficacy outcome (mortality and HF hospitalization) between LBBAP and Endo-CRT groups.
- Patients undergoing LBBAP experienced significantly shorter fluoroscopy times compared to the Endo-CRT group.
- The LBBAP group demonstrated a lower incidence of stroke during follow-up (0% vs. 11.5%, p=0.001).
Conclusions:
- Both LBBAP and Endo-CRT with conventional leads yield comparable rates of mortality, HF hospitalization, and left ventricular ejection fraction (LVEF) improvement.
- Endo-CRT is associated with longer fluoroscopy times and a higher risk of stroke.
- LBBAP presents a potentially safer alternative with procedural efficiencies.
Background:
Left bundle branch area pacing (LBBAP) and endocardial resynchronization (Endo-CRT) are alternatives to biventricular pacing for cardiac resynchronization therapy (CRT).
Objective:
To compare the outcomes of LBBAP versus Endo-CRT using conventional pacing leads.
Methods:
Patients with heart failure (HF) undergoing CRT with LBBAP or Endo-CRT were included. The primary efficacy outcome was a composite of HF-related hospitalization and all-cause mortality. The primary safety outcome was any procedure-related complication. Secondary outcomes included procedural characteristics, electrocardiographic, and echocardiographic parameters.
Results:
A total of 223 patients (LBBAP n = 197, Endo-CRT n = 26; mean age 69 ± 10.3 years, 32.3% female) were included. Patients in the LBBAP group had lower NYHA class, shorter preprocedural QRS durations (161 [142-183] vs. 180 [170-203] msec, p < .001), and a lower preprocedural spironolactone use (57.4% vs. 84.6%, p = .009) than patients in the Endo-CRT group. Fluoroscopy time was significantly shorter in patients undergoing LBBAP (11.4 [7.2-20] vs. 23 [14.2-34.5] min; p < .001). There was no significant difference in the primary efficacy outcome between both groups (Cox proportional HR 1.21, 95% CI 0.635-2.31; p = .56). During follow-up, patients undergoing LBBAP had a lower incidence of stroke than patients in the Endo-CRT group (0% vs. 11.5%, p = .001). Postprocedural LVEF (35% [25-45] vs. 40% [20-55]; p = .307) and change in LVEF (7% [0-20] vs. 11% [2-18]; p = .384) were similar between the LBBAP and the Endo-CRT groups, respectively.
Conclusion:
LBBAP and Endo-CRT using conventional leads are associated with similar mortality and HF-related hospitalization, as well as improvements in LVEF. Endo-CRT is associated with longer fluoroscopy times and a higher risk of stroke.
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