Left bundle cardiac resynchronization therapy versus left bundle optimized cardiac resynchronization therapy
Chinmay Parale1, Suresh Kumar Sukumaran1, Dinakar Bootla1
1Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Insights
Adding a coronary sinus lead to left bundle branch area pacing for cardiac resynchronization therapy (LB-CRT) did not show additional benefits compared to standard LB-CRT. Left bundle optimized CRT (LOT-CRT) showed similar outcomes in patients with non-ischemic cardiomyopathy and LBBB.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- Left bundle branch area pacing (LB-CRT) is a CRT technique.
- Left bundle optimized CRT (LOT-CRT) involves adding a coronary sinus lead to LB-CRT.
- The potential added benefit of LOT-CRT over LB-CRT requires investigation.
Purpose of the Study:
- To compare echocardiographic and clinical outcomes between LB-CRT and LOT-CRT.
- To evaluate the efficacy of LOT-CRT in patients with specific cardiac conditions.
Main Methods:
- A single-center randomized controlled trial was conducted.
- Patients with non-ischemic cardiomyopathy and LBBB (LVEF < 35%) were included.
- Participants were randomized to LB-CRT or LOT-CRT, with follow-up at 6 months.
Main Results:
- No significant difference in LVEF change between LB-CRT (15.7 ± 12.8%) and LOT-CRT (11.4 ± 14.2%).
- Response rates were comparable: 72.7% for LB-CRT and 71.4% for LOT-CRT.
- LVESV and 6-minute walk distance showed no significant differences between groups.
Conclusions:
- LOT-CRT does not provide additional benefit over LB-CRT in patients with non-ischemic cardiomyopathy and LBBB.
- Standard LB-CRT is as effective as LOT-CRT in this patient population.
Background:
In patients undergoing left bundle branch area pacing for cardiac resynchronization therapy (LB-CRT), addition of a coronary sinus lead i.e. Left bundle optimized CRT (LOT-CRT) might confer additional benefit.
Objectives:
To compare echocardiographic and clinical characteristics between LB-CRT and LOT-CRT at a 6 month follow up.
Materials And Methods:
This single center randomized controlled trial included patients with non-ischemic cardiomyopathy and left bundle branch block with left ventricular ejection fraction (LVEF) < 35% who underwent implantation of an atrial lead, a left bundle lead and a coronary sinus lead. Patients were randomized to LB-CRT or LOT-CRT 48 h after implant and followed-up for 6 months. LVEF, LV end systolic volume (LVESV), NYHA class, 6-min walk distance (6MWD) and response rates were compared between the two pacing modalities.
Results:
26 patients (12 in the LB-CRT group and 14 in the LOT-CRT group) were recruited in the study. The mean QRS duration of the population was 169.8 ± 20.6 ms and the mean LVEF was 21 ± 6.6%. Change in LVEF at 6 months (delta LVEF) in the LB-CRT group (15.7 ± 12.8%) was not significantly different from that in the LOT-CRT group (11.4 ± 14.2%; p = 0.43). Response rate in LB-CRT group (72.7%%), was comparable to that in the LOT-CRT group (71.4%; p = 0.94). LVESV, change in LVESV and 6MWD were also not significantly different between the two modalities.
Conclusions:
In patients with non-ischemic cardiomyopathy and LBBB, there was no additional benefit with LOT-CRT compared to LB-CRT.
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