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Observational Study
. 2023 Jul 18;82(3):228-241.
doi: 10.1016/j.jacc.2023.05.006. Epub 2023 May 21.

Comparison of Left Bundle Branch Area Pacing and Biventricular Pacing in Candidates for Resynchronization Therapy

Pugazhendhi Vijayaraman  1 , Parikshit S Sharma  2 , Óscar Cano  3 , Shunmuga Sundaram Ponnusamy  4 , Bengt Herweg  5 , Francesco Zanon  6 , Marek Jastrzebski  7 , Jiangang Zou  8 , Mihail G Chelu  9 , Kevin Vernooy  10 , Zachary I Whinnett  11 , Girish M Nair  12 , Manuel Molina-Lerma  13 , Karol Curila  14 , Dipen Zalavadia  15 , Abdul Haseeb  15 , Cicely Dye  2 , Sharath C Vipparthy  2 , Ryan Brunetti  5 , Pawel Moskal  16 , Alexandra Ross  11 , Antonius van Stipdonk  10 , Jerin George  17 , Yusuf K Qadeer  17 , Mishal Mumtaz  5 , Jeffrey Kolominsky  18 , Syeda A Zahra  11 , Mehrdad Golian  12 , Lina Marcantoni  6 , Faiz A Subzposh  15 , Kenneth A Ellenbogen  18
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Free article
Observational Study

Comparison of Left Bundle Branch Area Pacing and Biventricular Pacing in Candidates for Resynchronization Therapy

Pugazhendhi Vijayaraman et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is a well established therapy in patients with reduced left ventricular ejection fraction (LVEF), heart failure, and wide QRS or expected frequent ventricular pacing. Left bundle branch area pacing (LBBAP) has recently been shown to be a safe alternative to BVP.

Objectives: The aim of this study was to compare the clinical outcomes between BVP and LBBAP among patients undergoing CRT.

Methods: This observational study included patients with LVEF ≤35% who underwent BVP or LBBAP for the first time for Class I or II indications for CRT from January 2018 to June 2022 at 15 international centers. The primary outcome was the composite endpoint of time to death or heart failure hospitalization (HFH). Secondary outcomes included endpoints of death, HFH, and echocardiographic changes.

Results: A total of 1,778 patients met inclusion criteria: 981 BVP, 797 LBBAP. The mean age was 69 ± 12 years, 32% were female, 48% had coronary artery disease, and mean LVEF was 27% ± 6%. Paced QRS duration in LBBAP was significantly narrower than baseline (128 ± 19 ms vs 161 ± 28 ms; P < 0.001) and significantly narrower compared to BVP (144 ± 23 ms; P < 0.001). Following CRT, LVEF improved from 27% ± 6% to 41% ± 13% (P < 0.001) with LBBAP compared with an increase from 27% ± 7% to 37% ± 12% (P < 0.001) with BVP, with significantly greater change from baseline with LBBAP (13% ± 12% vs 10% ± 12%; P < 0.001). On multivariable regression analysis, the primary outcome was significantly reduced with LBBAP compared with BVP (20.8% vs 28%; HR: 1.495; 95% CI: 1.213-1.842; P < 0.001).

Conclusions: LBBAP improved clinical outcomes compared with BVP in patients with CRT indications and may be a reasonable alternative to BVP.

Keywords: biventricular pacing; cardiac resynchronization therapy; heart failure hospitalization; left bundle branch area pacing; mortality.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Vijayaraman has received honoraria and consultancy, research, and fellowship support from Medtronic; has served as a consultant for Abbott and Eaglepoint; has received honoraria from Boston Scientific and Biotronik; and has a patent for a His bundle pacing delivery tool. Dr Sharma has received honoraria from Medtronic; and has served as a consultant for Medtronic, Abbott, and Biotronik. Dr Cano has received honoraria from and served as a consultant for Medtronic, Biotronik, and Boston Scientific. Dr Ponnusamy has received honoraria from Medtronic. Dr Herweg has served as a speaker and consultant for Abbott; and has received speaking and fellowship support from Medtronic. Dr Jastrzebski has received honoraria from and served as a consultant for Medtronic and Abbott. Dr Zou has received honoraria from Abbott, Biotronik, Boston Scientific, Medtronic, and Microport. Dr Chelu has received research support from Patient-Centered Outcomes Research Institute, National Institutes of Health, Abbott, and Impulse Dynamics; and has received honorarium from Impulse Dynamics. Dr Vernooy has served as a consultant for Biosense Webster, Philips, Medtronic, Abbott, and Boston Scientific; and has received research and educational grants to his institution from Philips, Abbott, Medtronic, and Biosense Webster. Dr Whinnett has received honoraria from Medtronic and Boston Scientific; and has served as a consultant for Medtronic and Abbott. Dr Nair has received grants-in-aid from Biosense Webster, Medtronic, Canadian Institutes of Health Research, and Heart and Stroke Foundation of Canada; and has received honoraria and consulting fees from Medtronic, Biosense Webster, and Boston Scientific. Dr Curila has served as a consultant for and received honoraria from Medtronic, Biotronik, and Abbott. Dr Ellenbogen has served as a consultant for Medtronic, Boston Scientific, Abbott, and Biotronik; and has received honoraria from Medtronic, Boston Scientific, and Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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