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Randomized Controlled Trial
. 2022 Sep 27;80(13):1205-1216.
doi: 10.1016/j.jacc.2022.07.019.

Randomized Trial of Left Bundle Branch vs Biventricular Pacing for Cardiac Resynchronization Therapy

Yao Wang  1 , Haojie Zhu  2 , Xiaofeng Hou  1 , Zhao Wang  2 , Fengwei Zou  3 , Zhiyong Qian  1 , Yongyue Wei  4 , Xiang Wang  4 , Longyao Zhang  4 , Xiaofei Li  2 , Zhimin Liu  2 , Siyuan Xue  1 , Chaotong Qin  1 , Jiaxin Zeng  1 , Hui Li  2 , Hongping Wu  1 , Hong Ma  1 , Kenneth A Ellenbogen  5 , Michael R Gold  6 , Xiaohan Fan  7 , Jiangang Zou  8 ; LBBP-RESYNC Investigators
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Free article
Randomized Controlled Trial

Randomized Trial of Left Bundle Branch vs Biventricular Pacing for Cardiac Resynchronization Therapy

Yao Wang et al. J Am Coll Cardiol. .
Free article

Abstract

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 difference 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%). Crossovers 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 Resynchronization Therapy [LBBP-RESYNC]; NCT04110431).

Keywords: biventricular pacing; cardiac resynchronization therapy; heart failure; left bundle branch block; left bundle branch pacing.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported by the 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), and Chinese Academy of Medical Sciences Innovation Found for Medical Sciences (2020-I2M-C&T-B-007). Dr Ellenbogen has been a consultant for and has received honoraria and research support from Medtronic, Boston Scientific, Abbott, and Biotronik. Dr Gold has been a consultant for Medtronic, Boston Scientific, and EBR; has received research support from Medtronic, Boston Scientific, and Abbott; and has received honoraria from Medtronic and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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