Arrhythmias & electrophysiologyCohort study
Arrhythmic Risk in Biventricular Pacing Compared With Left Bundle Branch Area Pacing: Results From the I-CLAS Study
- Observational cohort study
- propensity-score matched
- multicentre (15 centres)
Authors' conclusion
LBBAP was associated with a lower incidence of sustained VT/VF and new-onset AF compared with BVP.
Study context
- Population
- Patients with LVEF ≤35% undergoing biventricular pacing (BVP) or left bundle branch area pacing (LBBAP) for cardiac resynchronization therapy, January 2018–June 2022matched cohort n = 1414
- Participants
- 1,778 patients
- Exposure
- LBBAP vs BVP for cardiac resynchronization therapy
- LBBAPn = 797
- BVPn = 981reference
- Outcome
- Sustained ventricular tachycardia (VT)/ventricular fibrillation (VF) and new-onset atrial fibrillation (AF) (in patients with no history of AF)
Main finding
Sustained VT/VF
Hazard ratio
0.46
95% CI 0.29–0.74
P < 0.001
By group
LBBAP vs BVP
HR 0.46 (95% CI 0.29–0.74); P < 0.001
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | LBBAP | BVP | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| New-onset AF >30 s (no history of AF, n=890) | 2.8% | 6.6% | 0.34 (0.16–0.73) | P = 0.008 | |
| VT/VF with no history of VT/VF or antiarrhythmic therapy (subgroup, n=1194) · LBBAP n=603, BVP n=591 | 3.2% | 7.3% | 0.46 (0.26–0.81) | P = 0.007 | |
| 0.10.31310Hazard ratio (log scale) |
AF lasting >24 hours (no history of AF)
P = 0.015
VT storm (>3 episodes in 24 hours)
P = 0.013
VT/VF in CRT pacemaker patients (subgroup, n=299) · LBBAP n=188, BVP n=111
P < 0.001
Original publication
Arrhythmic Risk in Biventricular Pacing Compared With Left Bundle Branch Area Pacing: Results From the I-CLAS Study. Circulation. Published 11 November 2023. doi:10.1161/circulationaha.123.067465
Summarised from the published abstract; every number is checked against it