Arrhythmias & electrophysiology
Comparison of Pacing Performance and Clinical Outcomes Between Left Bundle Branch and His Bundle Pacing
Main finding · Optimal device performanceResult — go to the resultAdjusted odds ratio 9.31 95% CI 5.14–16.86Authors' conclusion
Despite similar feasibility and safety profiles, LBBP confers additional benefits in pacing performance and reliability, shows trends towards improved survival compared to HBP
Study context
- Population
- Consecutive patients with LBBP or His-bundle pacing (HBP), 2 centres, 2018–2021282 successful conduction system pacing (CSP)
- Participants
- 338 patients
- Exposure
- LBBP vs HBP
- LBBPn = 163
- HBPn = 119reference
- Outcome
- Optimal device performance: pacing thresholds <2.5 V, R-wave amplitude ≥5 V and no conduction system pacing (CSP)-related complications
- Follow-up
- During
Methodological details2 centres, consecutive patients
- 2 centres
- Consecutive patients
Main finding
Optimal device performance
Adjusted odds ratio
9.31
95% CI 5.14–16.86
P < 0.001
By group
LBBPvs HBP
adjusted OR 9.31 (95% CI 5.14–16.86); P < 0.001
As reported in the abstract
Observational data: associations, not effects.
Secondary outcomes
| Outcome | LBBP | HBP | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| HF hospitalisation or all-cause mortalityP for 9%vs 24%; HR for event-free survival (trend) | 9% | 24% | 0.62 (0.31–1.23) | P = 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
Pacing threshold increase >1 V
- Pacing threshold increase >1 V: P < 0.001
HF hospitalisation or all-cause mortality
- Independent of pacing burden or pacing indication
Pacing parameters
- Lower pacing thresholds, higher R-wave amplitudes and lead impedance with LBBP
- P < 0.05
- Success rates did not differ between LBBP and HBP
- P > 0.05
Safety
CSP-related complications and reoperations
- No difference between LBBP and HBP
- P > 0.05
Original publication
Comparison of Pacing Performance and Clinical Outcomes Between Left Bundle Branch and His Bundle Pacing. JACC Clin Electrophysiol. Published 22 February 2023. doi:10.
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