PCWP Characterizes Responders of Left Bundle Branch Area Pacing in HFpEF Population

The hemodynamic and mechanical benefit of left bundle branch area pacing (LBBAP) in heart failure with preserved ejection fraction (HFpEF) remained underexplored.

The authors aimed to evaluate the hemodynamic and mechanical response of LBBAP in HFpEF population.

This cohort study includes patients with pacemaker-indicated symptomatic bradycardia and right heart catheterization (RHC) diagnosed HFpEF. Patients are consecutively enrolled from 2 treatment groups: 1 group receives LBBAP only, and the other receives right ventricular pacing (RVP) only. Periprocedural right heart catheterization and echocardiography were evaluated and compared. Primary endpoint was the composite of heart failure hospitalization (HFH) and all-cause mortality.

Two hundred one patients with HFpEF were included, 100 patients from RVP group and 101 patients from LBBAP group. Baseline characteristics were similar. Compared with RVP, LBBAP achieved better electrical synchrony with preserved hemodynamics and cardiac mechanics. With a median of 17.6 (13.5, 22.5) months, LBBAP also presented better survival for the primary endpoint (21.5% for RVP vs 9.5% for LBBAP; log-rank P = 0.024), contributed by reduced HFH incidence. Distinctively, LBBAP resulted in a more significant reduction of mean PCWP (-2.3 [-3.0, 0] mm Hg for RVP vs -4.0 [-4.9, -1.0] mm Hg for LBBAP; P < 0.001). Multivariate Cox model revealed that in the LBBAP group, Δmean PCWP predicted primary endpoint incidence (HR [95% CI]: 1.525 [1.118, 2.080]; P = 0.011).

In HFpEF population, LBBAP better preserved cardiac function and presented better survival for HFH compared with RVP. Reduction of PCWP might characterize the responders of LBBAP in HFpEF population.

NCT05575557.