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. 2024 Dec;21(12):2571-2578.
doi: 10.1016/j.hrthm.2024.06.019. Epub 2024 Jun 19.

Predictors of failed left bundle branch pacing implant in heart failure with reduced ejection fraction: Importance of left ventricular diameter and QRS morphology

Freddy R Graterol  1 , Margarida Pujol-López  1 , Roger Borràs  2 , Bernardo Ayala  3 , Laura Uribe  3 , Eduard Guasch  4 , Mariona Regany-Closa  1 , Mireia Niebla  1 , Esther Carro  3 , Jean-Baptiste Guichard  4 , M Ángeles Castel  4 , Elena Arbelo  4 , Andreu Porta-Sánchez  3 , Marta Sitges  4 , Josep Brugada  1 , Ivo Roca-Luque  4 , Adelina Doltra  1 , Lluís Mont  4 , José M Tolosana  5
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Free article

Predictors of failed left bundle branch pacing implant in heart failure with reduced ejection fraction: Importance of left ventricular diameter and QRS morphology

Freddy R Graterol et al. Heart Rhythm. 2024 Dec.
Free article

Abstract

Background: Left bundle branch pacing (LBBP) is considered an alternative to cardiac resynchronization therapy (CRT). However, LBBP is not suitable for all patients with heart failure.

Objective: The aim of our study was to identify predictors of unsuccessful LBBP implantation in CRT candidates.

Methods: A cohort of consecutive patients with indications for CRT were included. Clinical, echocardiographic, and electrocardiographic variables were prospectively recorded.

Results: A total of 187 patients were included in the analysis. LBBP implantation was successful in 152 of 187 patients (81.2%) and failed in 35 of 187 patients (18.7%). The causes of unsuccessful implantation were unsatisfactory paced QRS morphology (28 of 35 [80%]), inability to screw the helix (4 of 35 [11.4%]), lead instability (2 of 35 [5.7%]), and high pacing thresholds (1 of 35 [2.8%]). The left ventricular end-diastolic diameter (LVEDD), non-LBBB (left bundle branch block) QRS morphology, and QRS width were predictors of failed implantation according to the univariate analysis. According to the multivariate regression analysis, LVEDD (odds ratio 1.31 per 5-mm increase; 95% confidence interval 1.05-1.63 per 5-mm increase; P = .02) and non-LBBB (odds ratio 3.07; 95% confidence interval 1.08-8.72; P = .03) were found to be independent predictors of unsuccessful LBBP implantation. An LVEDD of 60 mm has 60% sensitivity and 71% specificity for predicting LBBP implant failure.

Conclusion: When LBBP was used as CRT, LVEDD and non-LBBB QRS morphology predicted unsuccessful implantation. Non-LBBB triples the likelihood of failed implantation independent of LVEDD. Caution should be taken when considering these parameters to plan the best pacing strategy for patients.

Keywords: Cardiac resynchronization therapy; Intraventricular conduction delay; Left bundle branch pacing; Left ventricular diameter; Successful implant.

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Conflict of interest statement

Disclosures Dr Pujol-López has received speaker honoraria from Medtronic. Dr Tolosana has received honoraria as a lecturer and consultant from Abbott, Boston Scientific, and Medtronic. Dr Mont has received unrestricted research grants, fellowship program support, and honoraria as a lecturer and consultant from Abbott, Biotronik, Boston Scientific, LivaNova, and Medtronic; he holds stock in Galgo Medical and Corify. Dr Roca-Luque has received honoraria as a lecturer and consultant from Abbott and Biosense Webster. Dr Sitges has received consultant fees and speaker honoraria from Abbott, Medtronic, General Electric, and Edwards Lifesciences. Dr Castel has received speaker honoraria from Boston Scientific, Abbott, and MicroPort. Dr Arbelo has received speaker honoraria from Biosense Webster and Bayer. Dr Porta-Sánchez has received honoraria as a lecturer and consultant from Biosense Webster, Abbott, and Boston Scientific. Dr Guichard has received honoraria as a consultant from MicroPort CRM, honoraria as a lecturer from MicroPort CRM and Abbott, and unrestricted grant support for a fellowship from Abbott. The remaining authors declare that they have no conflicts of interest.

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