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Article Abstract
Background: Left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) are considered to be acceptable as LBBAP strategies. Differences in clinical outcomes between LBBP and LVSP are yet to be determined.
Objectives: The purpose of this study was to compare the outcomes of LBBP vs LVSP vs BIVP for CRT.
Methods: In this prospective multicenter observational study, LBBP was compared with LVSP and BIVP in patients undergoing CRT. The primary composite outcome was freedom from heart failure (HF)-related hospitalization and all-cause mortality. Secondary outcomes included individual components of the primary outcome, postprocedural NYHA functional class, and electrocardiographic and echocardiographic parameters.
Results: A total of 415 patients were included (LBBP: n = 141; LVSP: n = 31; BIVP: n = 243), with a median follow-up of 399 days (Q1-Q3: 249.5-554.8 days). Freedom from the primary composite outcomes was 76.6% in the LBBP group and 48.4% in the LVSP group (HR: 1.37; 95% CI: 1.143-1.649; P = 0.001), driven by a 31.4% absolute increase in freedom from HF-related hospitalizations (83% vs 51.6%; HR: 3.55; 95% CI: 1.856-6.791; P < 0.001) without differences in all-cause mortality. LBBP was also associated with a higher freedom from the primary composite outcome compared with BIVP (HR: 1.43; 95% CI: 1.175-1.730; P < 0.001), with no difference between LVSP and BIVP.
Conclusions: In patients undergoing CRT, LBBP was associated with improved outcomes compared with LVSP and BIVP, while outcomes between BIVP and LVSP are similar.
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| http://dx.doi.org/10.1016/j.jacep.2023.10.016 | DOI Listing |
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Article Synopsis
- This study compared three pacing strategies for cardiac resynchronization therapy: left bundle branch pacing (LBBP), left ventricular septal pacing (LVSP), and biventricular pacing (BIVP).
- The primary outcome measured was freedom from heart failure-related hospitalizations and all-cause mortality, finding that LBBP significantly outperformed LVSP and showed better outcomes than BIVP.
- Results indicated that LBBP patients had a higher rate of freedom from heart failure hospitalizations (83%) compared to LVSP patients (51.6%) and similar outcomes between LVSP and BIVP.