Long-Term Outcomes of Left Bundle-Branch Pacing vs Biventricular Pacing in Heart Failure: The HeartSync-LBBP
Xueying Chen1,2,3,4,5, Xi Liu1,2,3,4,5, Ruogu Li6
1Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
Insights
Left bundle-branch pacing (LBBP) significantly reduced the risk of death or heart failure hospitalization compared to biventricular pacing (BiVP) in patients with left bundle-branch block (LBBB). This finding offers a superior alternative for heart failure management.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Left bundle-branch pacing (LBBP) is a potential alternative to biventricular pacing (BiVP) for heart failure patients with left bundle-branch block (LBBB).
- Robust clinical evidence from randomized trials comparing LBBP and BiVP is limited.
Purpose of the Study:
- To evaluate and compare the long-term clinical outcomes of LBBP versus BiVP in patients with LBBB and reduced left ventricular ejection fraction (LVEF).
Main Methods:
- A multicenter, prospective, randomized clinical trial involving 200 patients with LVEF ≤35% and LBBB.
- Patients were randomized 1:1 to receive either LBBP or BiVP.
- Primary endpoint: time to all-cause death or heart failure hospitalization (HFH).
Main Results:
- LBBP demonstrated a significantly lower rate of the primary endpoint (death or HFH) compared to BiVP (8% vs. 28%, P < .001).
- LBBP significantly reduced the risk of HFH (7.0% vs. 28.0%, P < .001) but showed no significant difference in all-cause mortality.
- Higher super-response rates (LVEF increase ≥15% or LVEF ≥50%) were observed with LBBP (55.0% vs. 36.0%, P < .007).
Conclusions:
- LBBP is superior to BiVP in reducing the risk of death or HFH for patients with LBBB and severely reduced LVEF.
- LBBP also promotes a greater improvement in LVEF.
- Further clinical trials are warranted to confirm these findings in this patient population.
Importance:
Left bundle-branch pacing (LBBP) has been proposed as an alternative to biventricular pacing (BiVP) for patients with heart failure with left bundle-branch block (LBBB). However, robust clinical evidence from randomized clinical trials is lacking.
Objective:
To evaluate the long-term clinical outcomes of LBBP and BiVP.
Design, Setting, And Participants:
This multicenter, prospective, randomized clinical trial enrolled 200 patients at 6 centers in China with a left ventricular ejection fraction (LVEF) of 35% or less and LBBB from October 2020 to March 2022. This study was took place from October 2020 to September 2024. These data were analyzed September 2024 to December 2024.
Interventions:
Patients were randomly assigned in a 1:1 ratio to receive either LBBP or BiVP.
Main Outcomes And Measures:
The primary end point was the time to death from any cause or heart failure hospitalization (HFH). The secondary end points included all-cause death, HFH, echocardiographic response (absolute increase in LVEF ≥5%), and super response (absolute increase in LVEF ≥15% or improvement of LVEF to ≥50%) rates.
Results:
Of the 200 included patients, 136 were male and 64 were female. The success rate was 98% in the LBBP group and 94% in the BiVP group (P = .28). The median follow-up duration was 36 (range, 33-39) months. The primary end point of time to death or HFH was significantly lower in the LBBP group compared with BiVP (8% vs 28%; hazard ratio [HR], 0.26; 95% CI, 0.12-0.57; P < .001). There was no significant difference in all-cause mortality between the groups (2.0% vs 5.0%; HR, 0.40; 95% CI, 0.08-2.04; P = .25). However, LBBP significantly reduced the risk of HFH (7.0% vs 28.0%; HR, 0.23; 95% CI, 0.10-0.52; P < .001). The echocardiographic response rates were similar in both groups (86.0% vs 81.0%; P = .34) but the super-response rate was higher in the LBBP group (55.0% vs 36.0%; P < .007).
Conclusions And Relevance:
In this study, LBBP was superior to BiVP in reducing the risk of death or HFH in patients with LBBB and severely reduced LVEF. Further trials are warranted in this patient population.
Trial Registration:
Chinese Clinical Trial Registry identifier: ChiCTR2000036554.
Related Concept Videos
01:29Cardiomyopathy V: Interprofessional Care
01:29Heart Failure II: Pathophysiology
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:22Heart Failure Drugs: β-Blockers
01:26Heart Failure Drugs: Inotropic Agents
01:22Heart Failure VI: Adjunct Therapies