1. Comparisons of long-term clinical outcomes with left bundle branch pacing, left ventricular septal pacing, and biventricular pacing for cardiac resynchronization therapy.
- Author
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Zhu H, Qin C, Du A, Wang Q, He C, Zou F, Li X, Tao J, Wang C, Liu Z, Xue S, Zeng J, Qian Z, Wang Y, Hou X, Ellenbogen KA, Gold MR, Yao Y, Zou J, and Fan X
- Subjects
- Humans, Male, Female, Aged, Treatment Outcome, Echocardiography, Bundle of His physiopathology, Stroke Volume physiology, Ventricular Septum physiopathology, Prospective Studies, Follow-Up Studies, Ventricular Function, Left physiology, Middle Aged, Bundle-Branch Block therapy, Bundle-Branch Block physiopathology, Time Factors, Ventricular Remodeling physiology, Cardiac Resynchronization Therapy methods, Heart Failure therapy, Heart Failure physiopathology, Heart Failure mortality
- Abstract
Background: Left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) are referred to as left bundle branch area pacing., Objective: This study investigated whether long-term clinical outcomes differ in patients undergoing LBBP, LVSP, and biventricular pacing (BiVP) for cardiac resynchronization therapy (CRT)., Methods: Consecutive patients with reduced left ventricular ejection fraction (LVEF <50%) undergoing CRT were prospectively enrolled if they underwent successful LBBP, LVSP, or BiVP. The primary composite end point was all-cause mortality or heart failure hospitalization. Secondary end points included all-cause mortality, heart failure hospitalization, and echocardiographic measures of reverse remodeling., Results: A total of 259 patients (68 LBBP, 38 LVSP, and 153 BiVP) were observed for a mean duration of 28.8 ± 15.8 months. LBBP was associated with a significantly reduced risk of the primary end point by 78% compared with both BiVP (7.4% vs 41.2%; adjusted hazard ratio [aHR], 0.22 [0.08-0.57]; P = .002) and LVSP (7.4% vs 47.4%; aHR, 0.22 [0.08-0.63]; P = .004]. The adjusted risk of all-cause mortality was significantly higher in LVSP than in BiVP (31.6% vs 7.2%; aHR, 3.19 [1.38-7.39]; P = .007) but comparable between LBBP and BiVP (2.9% vs 7.2%; aHR, 0.33 [0.07-1.52], P = .155). Propensity score adjustment also obtained similar results. LBBP showed a higher rate of echocardiographic response (ΔLVEF ≥10%: 60.0% vs 36.2% vs 16.1%; P < .001) than BiVP or LVSP., Conclusion: LBBP yielded long-term clinical outcomes superior to those of BiVP and LVSP. The role of LVSP for CRT needs to be reevaluated because of its high mortality risk., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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