Cardiac resynchronization therapy risk stratified by magnetic resonance imaging and optimized by left bundle branch pacing: Results from long-term follow-up of MADURAI LBBP study

Ponnusamy, SS; Ganesan, V; Ramalingam, V; Moghal, H; Kumar, S; Ramamoorthy, R; Syed, T; Murugan, M; Vijayaraman, P

doi:10.1016/j.hrthm.2025.04.040

Cardiac resynchronization therapy risk stratified by magnetic resonance imaging and optimized by left bundle branch pacing: Results from long-term follow-up of MADURAI left bundle branch pacing (LBBP) study

Heart RhythmPublished 26 Apr 2025prospective

Main finding · Composite of death, heart failure hospitalization, or VT or VF; echocardiographic response (ΔLVEF ≥ 15%) at 6 monthsResultEstimate 26.1% vs 6.9%

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Authors' conclusion

Cost-effective CRT may be safely provided by MAgnetic resonance imaging based DUal lead cardiac Resynchronization therapy: A prospectIve Left Bundle Branch Pacing (MADURAI LBBP) approach of risk stratifying patients with LB-NICM with late gadolinium enhancement cardiac magnetic resonance.

Study context

Population: Patients with LB-NICM, LVEF ≤ 35%, and heart failure, enrolled from 2019enrolled after excluding 6 patients
Participants: 225 patients

Exposure: LBBP only vs LBBP + implantable cardioverter defibrillator (ICD)
Group In = 202reference
Group IIn = 23
Outcome: Composite of death, heart failure hospitalization, or ventricular tachycardia (VT) or ventricular fibrillation (VF); echocardiographic response (ΔLVEF ≥ 15%) at 6 months
Follow-up: Mean 30 ± 19 months

Methodological detailslate gadolinium enhancement cardiac magnetic resonance imaging risk stratification

Late gadolinium enhancement cardiac magnetic resonance imaging risk stratification

Main finding

As reported in the abstract

Estimate

26.1% vs 6.9%

P = 0.0005

Observational data: associations, not effects.

Secondary outcomes

Echocardiographic hyper-response (LVEF ≥ 50%) · 6, 12, and 24 months · secondary end point

6 months

Group I64.8%

Group II5.2%

12 months

Group I74.6%

Group II25%

24 months

Group I82.2%

Group II25%

Predictors of normalization of LV function in group I

Smaller LV volumes, R-wave peak time ≤ 80 ms, LVEF 30% to 35%, and absence of scar

Predictors of adverse clinical events in group I

Left ventricular dimensions and presence of scar

Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.

Original publication

Cardiac resynchronization therapy risk stratified by magnetic resonance imaging and optimized by left bundle branch pacing: Results from long-term follow-up of MADURAI LBBP study. Heart Rhythm. Published 26 April 2025. doi:10.1016/j.hrthm.2025.04.040

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