Long-term benefits of single left ventricular pacing based on rate-adaptive atrioventricular delay algorithm in
Xuejing Yan1, Xuejuan Ma2, Lulu Zhao1
1Clinical Center of Heart Disease, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
Insights
Rate-adaptive atrioventricular delay (RAAVD) single left ventricular pacing (LUVP) significantly improves cardiac function, reduces rehospitalization, and extends battery longevity compared to biventricular pacing (BVP) in CRT patients.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Current cardiac resynchronization therapy (CRT) guidelines lack long-term data comparing single left ventricular pacing (LUVP) with biventricular pacing (BVP).
- This study addresses this gap by evaluating the clinical superiority of a novel RAAVD algorithm-guided LUVP over conventional BVP.
Purpose of the Study:
- To compare the long-term clinical outcomes and device performance of RAAVD LUVP versus BVP in patients with CRT and complete left bundle branch block (CLBBB).
- To assess the impact of RAAVD LUVP on disease-related rehospitalization, device complications, battery longevity, cardiac structure, function, and synchrony.
Main Methods:
- A retrospective cohort study included 67 patients with CRT and CLBBB, divided into RAAVD LUVP (n=42) and BVP (n=25) groups.
- Median follow-up was 43.59 months, with primary endpoints including rehospitalization, device complications, and battery longevity.
- Secondary outcomes assessed cardiac structure, function (LVEF, 6-minute walk distance), and synchrony (paced QRS duration, Ts-SD12).
Main Results:
- RAAVD LUVP showed significantly lower rehospitalization rates (23.8% vs. 48.0%, P=0.041) and zero device complications versus 12% in BVP (P=0.048).
- Battery longevity was extended with RAAVD LUVP (7.95±0.78 vs. 4.66±0.66 years, P<0.001).
- Significant improvements were observed in LVEF (45.7±13.3% vs. 38.9±10.6%, P=0.034), 6-minute walk distance (P=0.034), reduced LAD (P=0.018) and LVEDd (P=0.01), and better synchrony (paced QRS duration P=0.001, Ts-SD12 P=0.034).
Conclusions:
- RAAVD LUVP offers sustained clinical benefits over conventional BVP, aligning CRT more closely with physiological states.
- The dynamic integration of RAAVD LUVP with intrinsic conduction enhances cardiac function and synchrony.
- Left bundle branch area pacing (LBBAP), a subgroup of LUVP, demonstrated superior interventricular synchrony, highlighting the importance of pacing location.
Background:
Current guidelines lack long-term evidence comparing single left ventricular pacing (LUVP) with standard biventricular pacing (BVP) in cardiac resynchronization therapy (CRT). This study evaluates the clinical superiority of rate-adaptive atrioventricular delay (RAAVD) algorithm-guided LUVP over BVP.
Methods:
In this retrospective cohort study, 67 consecutive patients meeting the criteria for cardiac resynchronization therapy (CRT) with complete left bundle branch block (CLBBB) were enrolled between April 2013 and April 2023. They were assigned to either the right atrium-left ventricle dual-site pacing group (RAAVD LUVP, n = 42) or the biventricular pacing group (BVP, n = 25), with a median follow-up duration of 43.59 months. The primary endpoints included disease-related rehospitalization, device complications, and battery longevity. Secondary outcomes comprised cardiac structure, function, and synchrony.
Results:
There were no significant differences in baseline characteristics such as preoperative ejection fraction and cardiomyopathy type between the groups. The RAAVD LUVP group demonstrated significant advantages: i) Rehospitalization rate (23.8% vs. 48.0%, P = 0.041); ii) Zero device complications vs. 12% in BVP (P = 0.048), iii) Extended battery longevity (7.95 ± 0.78 vs. 4.66 ± 0.66 years, P < 0.001); iv) Cardiac function (LVEF: 45.7 ± 13.3% vs. 38.9 ± 10.6%, P = 0.034; The 6-minute walk distance: 414.50 ± 68.79 m vs. 379.04 ± 58.02 m; P = 0.034); v) Cardiac structure (LAD: 35.55 ± 7.11 mm vs. 39.96 ± 8.25 mm, P = 0.018; LVEDd: 60.10 ± 10.85 mm vs. 67.68 ± 9.40 mm, P = 0.01), and vi) Cardiac synchronization (paced QRS duration: 129.00 ± 18.78 vs. 147.96 ± 26.13 ms, P = 0.001; Ts-SD12: 96.66 ± 51.51 ms vs. 122.12 ± 52.29 ms; P = 0.034). Subgroup analysis revealed left bundle branch area pacing (LBBAP) further enhanced interventricular synchrony compared to lateral vein pacing (IVMD: 37.74 ± 21.24 vs. 53.11 ± 19.42 ms, P = 0.020).
Conclusion:
The dynamic integration of RAAVD LUVP with intrinsic conduction brings CRT closer to physiological states, which provides sustained clinical benefits compared to conventional BVP. The additional electromechanical advantages of LBBAP are related to the choice of anatomical location.
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