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Understanding LOT-CRT: Current Insights, Limitations, and Our Center's Experience

Georgios Leventopoulos1, Kassiani-Maria Nastouli1, Maria Bozika1

  • 1Department of Medicine, Division of Cardiology, University Hospital of Patras, 265 04 Patras, Greece.

Journal of Clinical Medicine
|May 14, 2025
PubMed

Insights

Left Bundle Branch Area Pacing Optimized cardiac resynchronization therapy (LOT-CRT) offers a promising alternative to biventricular pacing for heart failure patients. LOT-CRT demonstrates superior outcomes in selected populations, addressing non-responder limitations.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Biventricular pacing (BiV) is standard for heart failure (HF) with reduced ejection fraction and dyssynchrony, but 33% of patients do not respond.
  • Left bundle branch area pacing (LBBAP) offers physiological pacing but is limited by atypical LBBB or IVCD.
  • A novel approach, LOT-CRT, combines LBBAP with coronary sinus (CS) lead pacing to enhance electrical synchrony.

Purpose of the Study:

  • To review the feasibility, advantages, disadvantages, and clinical outcomes of LOT-CRT.
  • To compare LOT-CRT with BiV-CRT and LBBAP alone.
  • To propose an evidence-based implantation algorithm for LOT-CRT.

Main Methods:

  • Systematic review of published studies on LOT-CRT.
  • Comparison of LOT-CRT with BiV-CRT and LBBAP using QRS narrowing, LVEF, remodeling, NYHA class, and NT-proBNP.
  • Inclusion of single-center experience and algorithm development.

Main Results:

  • LOT-CRT shows improved outcomes compared to BiV-CRT or LBBAP alone in specific patient groups.
  • Achieving these benefits requires advanced clinical skills, longer procedures, and specialized device configurations.
  • Randomized trials are ongoing to further validate LOT-CRT's efficacy.

Conclusions:

  • LOT-CRT represents a significant advancement in cardiac resynchronization therapy for non-responders to conventional CRT.
  • Careful patient selection and procedural expertise are crucial for successful LOT-CRT implementation.
  • Further research, including randomized controlled trials, is essential to solidify LOT-CRT's role in clinical practice.

Keywords:
LOT-CRTQRS narrowingcardiac resynchronization therapyelectrophysiologyheart failureintraventricular conduction delayleft bundle branch pacing

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