Outcomes of Upgrading to LBBP in CRT Nonresponders: A Prospective, Multicenter, Nonrandomized, Case-Control Study

Chen, X; Jin, Q; Qiu, Z; Qian, C; Liang, Y; Wang, J; Qin, S; Bai, J; Wang, W; Chen, H; Dong, Y; Huang, W; Su, Y

doi:10.1016/j.jacep.2023.08.031

Outcomes of Upgrading to Left-bundle Branch Pacing (LBBP) in Cardiac Resynchronization Therapy (CRT) Nonresponders: A Prospective, Multicenter, Nonrandomized, Case-Control Study

JACC Clin ElectrophysiolPublished 8 Nov 2023Randomised controlled trial

Primary result · Composite of HF rehospitalization, all-cause death or heart transplantationResultHazard ratio 0.31 95% CI 0.14–0.72

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Authors' conclusion

Upgrading to LBBP is feasible and effective in achieving significant heart function improvement and better clinical outcomes in CRT nonresponders

Study context

Population: CRT nonresponders (CRT-pacemaker or CRT-defibrillator >12 months, nonresponsive after optimal medical therapy and device optimization)Propensity-score matching (PSM) 1:1 paired cohorts
Participants: 145 participants

Comparison: Upgrade to LBBP vs continued biventricular pacing in CRT nonresponders
LBBPn = 48
Biventricular pacing (BVP)n = 97reference
Primary endpoint: Composite of:
HF-related rehospitalization
All-cause death
Heart transplantation
Follow-up: Median 24 months

Methodological detailspropensity-score matched, 1:1 matching

Propensity-score matched
1:1 matching

Primary result

As reported in the abstract

Composite of:

HF rehospitalization
All-cause death
Heart transplantation

Hazard ratio

0.31

95% CI 0.14–0.72

log-rank P = 0.007

LBBPvs BVP

HR 0.31 (95% CI 0.14–0.72); log-rank P = 0.007

Further findings

Outcome	LBBP	BVP
LVEF · baseline, 6 and 12 monthsLBBP values: baseline; BVP values: baseline vs follow-up	29.75% (SD 7.79%)	29.55% (SD 6.74%)
6 months	37.78% ± 9.25% (P < 0.001)	— not stated in the abstract
12 months	38.84% ± 12.13% (P < 0.001)	— not stated in the abstract
Follow-up	— not stated in the abstract	29.22% ± 8.10% (P = 0.840)

— not stated in the abstract

Successful upgrade to LBBP: 97.96% · 48
Successful upgrade to LBBP — Significant decrease in QRS duration: P < 0.001
Echocardiographic response (LBBP): 47.73% · 21

Successful upgrade to LBBP: 48/49 patients
Echocardiographic response (LBBP): 21/44 patients

Echocardiographic response (LBBP)

LV end-diastolic volume and baseline LBBB QRS morphology independent predictors of response

Original publication

Outcomes of Upgrading to LBBP in CRT Nonresponders: A Prospective, Multicenter, Nonrandomized, Case-Control Study. JACC Clin Electrophysiol. Published 8 November 2023. doi:10.1016/j.jacep.2023.08.031

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