Left Bundle Branch Area Pacing vs. Biventricular Pacing for Cardiac Resynchronization: Propensity Score Analysis

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Left bundle branch area pacing (LBBAP) is an emerging alternative to biventricular pacing (BIVP) for cardiac resynchronization therapy (CRT).
• Previous data suggest LBBAP may offer superior outcomes, but more evidence is needed.
• This study compares LBBAP and BIVP for de novo CRT indications.

Purpose of the Study:

• To compare procedural and clinical outcomes between LBBAP and BIVP in patients undergoing de novo cardiac resynchronization therapy.
• To evaluate the safety and efficacy of LBBAP as an alternative to BIVP.
• To assess long-term outcomes including heart failure hospitalizations and mortality.

Main Methods:

• Retrospective study of 314 patients undergoing de novo CRT at two French centers (2022-2024).
• Patients were divided into LBBAP (n=75) and BIVP (n=239) groups.
• Inverse probability weighting propensity score (IPW-PS) was used to compare outcomes.

Main Results:

• LBBAP was associated with shorter procedure times, narrower paced QRS, and fewer post-discharge complications compared to BIVP.
• One-year improvements in left ventricular ejection fraction and hyper-response rates were similar between groups.
• After IPW-PS, no significant differences were found in heart failure hospitalizations, arrhythmias, or mortality between LBBAP and BIVP.

Conclusions:

• LBBAP demonstrates comparable resynchronization and clinical outcomes to BIVP for cardiac resynchronization therapy.
• LBBAP is associated with a significant reduction in late device-related complications.
• LBBAP represents a viable and potentially safer alternative to conventional BIVP.