Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 80, Issue 13, Pages 1205-1216Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2022.07.019
Keywords
biventricular pacing; cardiac resynchronization therapy; heart failure; left bundle branch block; left bundle branch pacing
Categories
Funding
- National Natural Science Foundation of China [82070521, 81970284]
- Clinical Competence Improvement Project of Jiangsu Province Hospital [JSPH-MA-2020-3]
- Project on New Technology of Jiangsu Province [JX233C202103]
- Chinese Academy of Medical Sciences Innovation Found for Medical Sciences [2020-I2M-CT-B-007]
- Medtronic
- Boston Scientific
- Abbott
- Biotronik
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Left bundle branch pacing (LBBP) shows greater improvement in left ventricular ejection fraction (LVEF) compared to biventricular pacing (BiVP) in heart failure patients with nonischemic cardiomyopathy and left bundle branch block (LBBB).
BACKGROUND Left bundle branch pacing (LBBP) is the most rapidly growing conduction system pacing technique that is capable of correcting intrinsic left bundle branch block (LBBB). As such, it is potentially an optimal alternative to cardiac resynchronization therapy (CRT) with biventricular pacing (BiVP).OBJECTIVES The authors sought to compare the efficacy of LBBP-CRT with BiVP-CRT in patients with heart failure and reduced left ventricular ejection fraction (LVEF).METHODS This is a prospective, randomized trial of patients with nonischemic cardiomyopathy and LBBB with 6-month preplanned follow-up. Crossovers were allowed if LBBP or BiVP were unsuccessful. The primary endpoint was the dif-ference in LVEF improvement between 2 groups. The secondary endpoints included changes in echocardiographic measurements, N-terminal pro-B-type natriuretic peptide (NT-proBNP), New York Heart Association functional class, 6-minute walk distance, QRS duration, and CRT response.RESULTS The study included 40 consecutive patients (20 males, mean age 63.7 years, LVEF 29.7% +/- 5.6%). Cross-overs occurred in 10% of LBBP-CRT and 20% of BiVP-CRT. All patients completed follow-up. Intention-to-treat analysis showed significantly higher LVEF improvement at 6 months after LBBP-CRT than BiVP-CRT (mean difference: 5.6%; 95% CI: 0.3-10.9; P = 0.039). LBBP-CRT also appeared to have greater reductions in left ventricular end-systolic volume (-24.97 mL; 95% CI: -49.58 to -0.36 mL) and NT-proBNP (-1,071.80 pg/mL; 95% CI: -2,099.40 to -44.20 pg/mL), and comparable changes in New York Heart Association functional class, 6-minute walk distance, QRS duration, and rates of CRT response compared with BiVP-CRT.CONCLUSIONS LBBP-CRT demonstrated greater LVEF improvement than BiVP-CRT in heart failure patients with nonischemic cardiomyopathy and LBBB. (Left Bundle Branch Pacing Versus Biventricular Pacing for Cardiac Resynchro-nization Therapy [LBBP-RESYNC]; NCT04110431) (J Am Coll Cardiol 2022;80:1205-1216) (c) 2022 by the American College of Cardiology Foundation.
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