Left Bundle Branch Area Pacing Versus Biventricular Pacing as Initial Strategy for Cardiac Resynchronization

doi:10.1016/j.jacep.2023.04.015

Heart failure & cardiomyopathies

Left Bundle Branch Area Pacing Versus Biventricular Pacing as Initial Strategy for Cardiac Resynchronization

JACC Clin ElectrophysiolPublished 21 May 2023Prospective cohort study

Main findingResultHazard ratio 0.621 95% CI 0.415–0.93

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Authors' conclusion

LBBAP as an initial CRT strategy resulted in a lower risk of HF-related hospitalizations compared to BiVp. A reduction in procedural and fluoroscopy times, shorter paced QRS duration, and improvements in left ventricular ejection fraction compared with BiVp were observed.

Study context

Population: First-time cardiac resynchronization therapy (CRT) implant recipients
Participants: 371 recipients

Exposure: Left bundle branch area pacing (LBBAP) vs biventricular pacing (BiVp) as initial CRT implant strategy
Outcome: Composite of:
Heart failure (HF)-related hospitalisation
All-cause mortality
Follow-up: Median 340 days (IQR 206-477 days)

Methodological detailsmulticentre, observational, nonrandomised

Multicentre
Observational
Nonrandomised

Main finding

As reported in the abstract

Hazard ratio

0.621

95% CI 0.415–0.93

P = 0.021

By group

LBBAP24.2%

BiVp42.4%

LBBAPvs BiVp

HR 0.621 (95% CI 0.415–0.93); P = 0.021

Observational data: associations, not effects.

Secondary outcomes

Outcome	LBBAP	BiVp	← Lower risk with LBBAP ←→ Higher risk with LBBAP →	HR (95% CI)	P value
HF-related hospitalisation (primary component)	22.6%	39.5%	0.20.5125	0.607 (0.397–0.927)	P = 0.021
			0.20.5125Hazard ratio (log scale)

All-cause mortality (primary component) · not significant

P = 0.19

LBBAP5.5%

BiVp11.9%

Procedural time

P < 0.001

LBBAP95 minutesIQR 65–120

BiVp129 minutesIQR 103–162

Fluoroscopy time

P < 0.001

LBBAP12 minutesIQR 7.4–21.1

BiVp21.7 minutesIQR 14.3–30

QRS duration

P < 0.001

LBBAP123.7 millisecondsSD 18

BiVp149.3 millisecondsSD 29.1

Outcome	LBBAP	BiVp	P value
Postprocedural LVEF	34.1% (SD 12.5%)	31.4% (SD 10.8%)	P = 0.041

Safety

Long-term complications · no significant difference

P = 0.146

LBBAP9.4%

BiVp15.2%

Original publication

Left Bundle Branch Area Pacing Versus Biventricular Pacing as Initial Strategy for Cardiac Resynchronization. JACC Clin Electrophysiol. Published 21 May 2023. doi:10.1016/j.jacep.2023.04.015

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