Cost-effective CRT using dual-chamber generators in patients without atrial pacing need

Cardiac resynchronization therapy (CRT) improves outcomes in patients with reduced left ventricular ejection fraction, but device cost limits access. In patients without atrial pacing needs, the atrial port of a dual-chamber pacemaker or ICD can be repurposed for conduction system pacing to deliver CRT. We retrospectively analyzed 18 patients who underwent left bundle branch area pacing using a dual-chamber generator. The left bundle branch lead was connected to the atrial port. Over 12 months, LVEF remained stable in patients with pacemakers, with modest QRS narrowing, and limited ICD data suggested LVEF improvement. No intra-procedural complications occurred, and one patient developed a self-resolving pericardial effusion. No inappropriate ICD therapies were observed. Cost analysis demonstrated savings of $3,922 per CRT-D and $2,963 per CRT-P device avoided. Delivering CRT via dual-chamber generators in patients without atrial pacing needs is feasible, safe, and cost-effective, potentially broadening access to CRT, particularly in resource-limited settings. Larger studies are needed to confirm these findings.