Heart failure & cardiomyopathies
Biventricular endocardial pacing and left bundle branch area pacing for cardiac resynchronization: Mechanistic insights from electrocardiographic imaging, acute hemodynamic response, and magnetic resonance imaging
Authors' conclusion
Our findings suggest superior electrical resynchronization and a higher proportion of acute hemodynamic responders during BiV-endo and LBBAP compared to BiV-epi. Electrical resynchronization was similar between BiV-endo and LBBAP; however, septal scar seemed to attenuate response to LBBAP.
Study context
- Population
- Patients with HF and indications for cardiac resynchronization therapy (CRT)10 completed protocol
- Participants
- 11 patients
- Comparison
- BiV-endo and left bundle branch area pacing (LBBAP) vs biventricular epicardial pacing (BiV-epi)
- Outcome
- Acute electrical resynchronization (LVAT-95, LVDI, BIVAT-90, BIVDI by electrocardiographic imaging (ECGi)) and acute hemodynamic response
Methodological detailsacute temporary pacing study, within-patient comparison
- Acute temporary pacing study
- Within-patient comparison
Main finding
As reported in the abstract
LV resynchronization (LVAT-95, LVDI)
| Group | LV activation time (LVAT-95) | LV dyssynchrony index (LVDI) |
|---|---|---|
| BiV-epi | 79.2 ± 13.1 ms | 26.6 ± 3.4 ms |
| BiV-endo | 48.5 ± 14.9 ms | 16.6 ± 6.4 ms |
| LBBAP | 48.9 ± 12.5 ms | 15.3 ± 3.4 ms |
LV activation time (LVAT-95)
BiV-epi79.2 ± 13.1 ms
BiV-endo48.5 ± 14.9 ms
LBBAP48.9 ± 12.5 ms
LV dyssynchrony index (LVDI)
BiV-epi26.6 ± 3.4 ms
BiV-endo16.6 ± 6.4 ms
LBBAP15.3 ± 3.4 ms
- BiV-endo vs BiV-epi: P = 0.001 — LVAT-95
- BiV-endo vs BiV-epi: P = 0.002 — LVDI
- LBBAP vs BiV-epi: P = 0.001 — LVAT-95
- LBBAP vs BiV-epi: P = 0.001 — LVDI
Further findings
Acute hemodynamic responders
Biventricular resynchronization (biventricular activation time (BIVAT-90), biventricular dyssynchrony index (BIVDI))
- Superior during BiV-endo and LBBAP vs BiV-epi
- P < 0.05
Effect of septal scar on left ventricular (LV) resynchronization (magnetic resonance imaging (MRI) subset)
- Benefits of LBBAP (but not BiV-endo) attenuated when septal scar present
- Subset of 8 patients who underwent MRI
Original publication
Biventricular endocardial pacing and left bundle branch area pacing for cardiac resynchronization: Mechanistic insights from electrocardiographic imaging, acute hemodynamic response, and magnetic resonance imaging. Heart Rhythm. Published 28 October 2022. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →