Clinical outcomes of left bundle branch area pacing in heart failure patients with typical or atypical left bundle
Yonghong Yang1, Zijun Zhao1, Yushi Luo1
1Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China.
Insights
Left bundle branch area pacing (LBBAP) significantly improves cardiac remodeling and clinical outcomes in heart failure patients with typical left bundle branch block (t-LBBB). Patients with atypical LBBB (a-LBBB) showed poorer response to LBBAP.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- The diagnostic criteria for left bundle branch block (LBBB) can influence the effectiveness of left bundle branch area pacing (LBBAP).
- Understanding the differential response to LBBAP based on LBBB classification is crucial for optimizing heart failure (HF) treatment.
Purpose of the Study:
- To compare the echocardiographic and clinical outcomes of LBBAP in HF patients with typical LBBB (t-LBBB) versus atypical LBBB (a-LBBB).
Main Methods:
- Ninety-seven HF patients (LVEF <50%) who underwent LBBAP were retrospectively analyzed.
- Patients were classified into t-LBBB (n=82) and a-LBBB (n=15) groups based on Strauss criteria.
- Baseline characteristics, pacing parameters, and clinical outcomes were compared between groups.
Main Results:
- The t-LBBB group showed significant improvements in left ventricular dimensions and ejection fraction post-LBBAP.
- Response rates (91.5% vs. 33.3%) and hyper-response rates (59.8% vs. 13.3%) were significantly higher in the t-LBBB group.
- The t-LBBB group experienced lower rates of all-cause mortality, HF hospitalizations, and composite endpoints compared to the a-LBBB group.
Conclusions:
- LBBAP demonstrates superior efficacy in reversing cardiac remodeling for HF patients with t-LBBB compared to those with a-LBBB.
- LBBAP significantly improves clinical outcomes in HF patients with t-LBBB, including reduced mortality and hospitalizations.
- The classification of LBBB is a critical factor in predicting the success of LBBAP in heart failure management.
Background:
The impact of stricter definition of left bundle branch block (LBBB) on echocardiographic response of left bundle branch area pacing (LBBAP) and clinical outcomes remains unclear.
Aims:
This study aimed to compare the effects of LBBAP in heart failure (HF) patients with typical left bundle branch block (t-LBBB) versus atypical LBBB (a-LBBB).
Methods:
Ninety-seven patients with LBBB and left ventricular ejection fraction <50% who successfully underwent LBBAP were enrolled. Patients were categorized into a t-LBBB group (n = 82) and an a-LBBB group (n = 15) based on Strauss criteria. Baseline characteristics, pacing parameters, and clinical outcomes were compared between the two groups.
Results:
In the t-LBBB group, the left ventricular end-diastolic dimension decreased from 63.9 (8.3) mm to 53.5 (8.2) mm (P <0.001), and the left ventricular ejection fraction improved from 33.3 (8.1)% to 51.1 (11.1)% (P <0.001). Compared with the a-LBBB group, the t-LBBB group had a higher proportionof responders (91.5% vs. 33.3%; P <0.001) and hyper-responders (59.8% vs. 13.3%; P <0.001). Also, the t-LBBB group showed lower incidence of death from any cause (2.4% vs. 20.0%; log-rank P = 0.005), HF hospitalizations (6.1% vs. 46.7%; log-rank P <0.001), and the primary composite endpoint (8.5% vs. 60.0%; log-rank P <0.001).
Conclusions:
Compared to HF patients with a-LBBB, LBBAP significantly reverses cardiac remodeling and improves clinical outcomes in those with t-LBBB.
Related Concept Videos
01:22Heart Failure Drugs: β-Blockers
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:30Heart Failure IV: Classification and Diagnostic Evaluation
01:29Cardiomyopathy V: Interprofessional Care