Heart failure & cardiomyopathies
Multicenter Hemodynamic Assessment of the LOT-CRT Strategy: When Does Combining Left Bundle Branch Pacing and Coronary Venous Pacing Enhance Resynchronization?: Primary Results of the CSPOT Study
Authors' conclusion
In a CRT cohort with advanced conduction disease, LOT-CRT and BVP provided greater acute hemodynamic benefit than LBBAP. Subjects with wider QRS or deep septal pacing are more likely to benefit from the addition of a left ventricular coronary vein lead to implement LOT-CRT.
Study context
- Population
- Cardiac resynchronization therapy (CRT) candidates with advanced conduction disease (nonspecific interventricular conduction delay n=29 or LBBB n=19)
- Participants
- 48 candidates
- Comparison
- LOT-CRT vs biventricular pacing (BVP) vs left bundle branch area pacing (LBBAP)
- Outcome
- Change in LV dP/dtmax from baseline atrial pacing
- Follow-up
- Acute
Methodological detailsmulticentre, within-patient comparison of pacing modes
- Multicentre
- Within-patient comparison of pacing modes
Main finding
As reported in the abstract
AV-optimized increase in LV dP/dtmax
- LOT-CRT and BVP greater than unipolar or bipolar LBBAP
- P ≤ 0.005
Further findings
| Outcome | Values | Difference in LV dP/dtmax improvement (CI) | P value | |
|---|---|---|---|---|
| Added LV coronary vein pacing (LOT-CRT vs LBBAP), QRS ≥171 ms and deep septal pacing — LOT-CRT vs LBBAP | 14.5% (5.0%–24.1%) | |||
| −100102030Difference (linear scale) |
| Outcome | Values | Difference in QRS shortening (ms) (CI) | P value | |
|---|---|---|---|---|
| Added LV coronary vein pacing (LOT-CRT vs LBBAP), QRS ≥171 ms and deep septal pacing — LOT-CRT vs LBBAP | 20.8 (12.8–28.8) | |||
| −2002040Difference, ms (linear scale) |
| Outcome | Values | Estimate | P value |
|---|---|---|---|
| QRS shortening | LOT-CRT 29.5 (95% CI 23.4–35.6) ms · Unipolar LBBAP 11.9 (95% CI 6.1–17.7) ms · Bipolar LBBAP 11.7 (95% CI 6.4–17.0) ms · BVP 18.5 (95% CI 11.0–25.9) ms | ||
| Bipolar vs unipolar LBBAP: LV dP/dtmax improvement | Bipolar LBBAP 18.6% · Anodal capture 54% · Unipolar LBBAP 23.7% | P < 0.001 |
- QRS shortening — LOT-CRT greater than each other mode
- all P≤0.005
- Added LV coronary vein pacing (LOT-CRT vs LBBAP), QRS ≥171 ms and deep septal pacing — Benefit depended on baseline QRS duration
- P=0.031
- Added LV coronary vein pacing (LOT-CRT vs LBBAP), QRS ≥171 ms and deep septal pacing — Benefit depended on success of LBBAP
- P<0.004
Interventricular conduction delay vs LBBB (subgroup)
- Less QRS reduction with interventricular conduction delay
- P = 0.026
- Similar LV dP/dtmax improvement
- P = 0.29
LBBAP capture type (EHRA criteria)
- LBBAP or LV septal pacing
- 27 (56%)
- Deep septal pacing
- 21 (44%)
Original publication
Multicenter Hemodynamic Assessment of the LOT-CRT Strategy: When Does Combining Left Bundle Branch Pacing and Coronary Venous Pacing Enhance Resynchronization?: Primary Results of the CSPOT Study. Circ Arrhythm Electrophysiol. Published 23 October 2024. doi:10.
Summarised from the published abstract; every number is checked against it