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Multicenter Study
. 2021 Feb;7(2):135-147.
doi: 10.1016/j.jacep.2020.08.015. Epub 2020 Oct 28.

Left Bundle Branch Area Pacing for Cardiac Resynchronization Therapy: Results From the International LBBAP Collaborative Study Group

Pugazhendhi Vijayaraman  1 , ShunmugaSundaram Ponnusamy  2 , Óscar Cano  3 , Parikshit S Sharma  4 , Angela Naperkowski  5 , Faiz A Subsposh  5 , Pawel Moskal  5 , Agnieszka Bednarek  6 , Alexander R Dal Forno  7 , Wilson Young  5 , Sudip Nanda  8 , Dominik Beer  5 , Bengt Herweg  9 , Marek Jastrzebski  6
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Free article
Multicenter Study

Left Bundle Branch Area Pacing for Cardiac Resynchronization Therapy: Results From the International LBBAP Collaborative Study Group

Pugazhendhi Vijayaraman et al. JACC Clin Electrophysiol. 2021 Feb.
Free article

Abstract

Objectives: The aim of this study was to assess the feasibility and outcomes of left bundle branch area pacing (LBBAP) in patients eligible for cardiac resynchronization therapy (CRT) in an international, multicenter, collaborative study.

Background: CRT using biventricular pacing is effective in patients with heart failure and left bundle branch block (LBBB). LBBAP has been reported as an alternative option for CRT.

Methods: LBBAP was attempted in patients with left ventricular ejection fraction (LVEF) <50% and indications for CRT or pacing. Procedural outcomes, left bundle branch capture, New York Heart Association functional class, heart failure hospitalization, echocardiographic data, and lead complications were recorded. Clinical (no heart failure hospitalization and improvement in New York Heart Association functional class) and echocardiographic responses (≥5% improvement in LVEF) were assessed.

Results: LBBAP was attempted in 325 patients, and CRT was successfully achieved in 277 (85%) (mean age 71 ± 12 years, 35% women, ischemic cardiomyopathy in 44%). QRS configuration at baseline was LBBB in 39% and non-LBBB in 46%. Procedure and fluoroscopy duration were 105 ± 54 and 19 ± 15 min, respectively. LBBAP threshold and R-wave amplitudes were 0.6 ± 0.3 V at 0.5 ms and 10.6 ± 6 mV at implantation and remained stable during mean follow-up of 6 ± 5 months. LBBAP resulted in significant QRS narrowing from 152 ± 32 to 137 ± 22 ms (p < 0.01). LVEF improved from 33 ± 10% to 44 ± 11% (p < 0.01). Clinical and echocardiographic responses were observed in 72% and 73% of patients, respectively. Baseline LBBB (odds ratio: 3.96; 95% confidence interval: 1.64 to 9.26; p < 0.01) and left ventricular end-diastolic diameter (odds ratio: 0.62; 95% confidence interval: 0.49 to 0.79; p < 0.01) were independent predictors of echocardiographic response.

Conclusions: LBBAP is feasible and safe and provides an alternative option for CRT. LBBAP provides remarkably low and stable pacing thresholds and was associated with improved clinical and echocardiographic outcomes.

Keywords: His bundle pacing; biventricular pacing; bundle branch block; cardiac resynchronization therapy; left bundle branch area pacing.

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Conflict of interest statement

Funding Support and Author Disclosures Dr. Vijayaraman has received honoraria, consulting fees, and research support from Medtronic; and has received consulting fees from Boston Scientific, Abbott, Biotronik, and Eaglepoint. Dr. Sharma has received honoraria from Medtronic; and has received consulting fees from Abbott, Biotronik, and Boston Scientific. Dr. Subsposh has received honoraria from Medtronic. Dr. Herweg has received honoraria and consulting fees from Abbott and Biotronik. Dr. Jastrzebski has received consulting fees and honoraria from Medtronic and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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