Left bundle branch area vs biventricular pacing for cardiac resynchronization therapy: the LEFT-BUNDLE-CRT trial

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Conduction system pacing offers an alternative to biventricular pacing (BiVP) for cardiac resynchronization therapy (CRT).
• Left-bundle branch area pacing (LBBAP) is a novel conduction system pacing technique.
• Assessing LBBAP's efficacy against BiVP in CRT is crucial.

Purpose of the Study:

• To evaluate if left-bundle branch area pacing (LBBAP) is non-inferior to biventricular pacing (BiVP) for cardiac resynchronization therapy (CRT).
• To compare CRT response rates between LBBAP-CRT and BiVP-CRT in eligible patients.

Main Methods:

• A multi-center, randomized, non-inferiority trial (left-bundle CRT trial) was conducted.
• Patients with CRT indications and left-bundle branch block were randomized to BiVP-CRT or LBBAP-CRT.
• The primary endpoint was a positive CRT response at 6 months, defined by clinical composite score improvement or ≥15% reduction in left ventricular end-systolic volume.

Main Results:

• The study included 176 patients randomized to BiVP-CRT (n=84) or LBBAP-CRT (n=92).
• In intention-to-treat analysis, 94.6% of BiVP-CRT patients and 89.7% of LBBAP-CRT patients achieved the primary endpoint, not meeting non-inferiority.
• Secondary outcomes, adverse events, and heart failure hospitalization rates were similar between the groups.

Conclusions:

• Left-bundle branch area pacing-cardiac resynchronization therapy (LBBAP-CRT) was not non-inferior to biventricular pacing-cardiac resynchronization therapy (BiVP-CRT) in CRT candidates with typical LBBB.
• Both LBBAP-CRT and BiVP-CRT demonstrated high response rates and comparable clinical outcomes.
• Further research may explore optimal patient selection for LBBAP.