Abstract 11215: Cardiac Resynchronization Therapy via Left Bundle Branch Pacing Vvrsus Optimized Biventricular Pacing with Adaptive Algorithm in Heart Failure with Left Bundle Branch Block: A Prospective, Multi-Center, Observational Study

Abstract

Objectives: The purpose of our study was to evaluate the feasibility and efficacy of cardiac resynchronization therapy (CRT) via left bundle branch pacing (LBBP-CRT) compared with optimized bi-ventricular pacing (BVP) with adaptive algorithm (BVP-aCRT) in heart failure with reduced left ventricular ejection fraction≤35% (HFrEF) and left bundle branch block (LBBB). Methods: One hundred patients with HFrEF and LBBB undergoing CRT were prospectively enrolled in a non-randomized fashion and divided into 2 groups (LBBP-CRT, n=49; BVP-aCRT, n=51) in 4 centers. Implant characteristics and echocardiographic parameters were accessed at baseline and during 6-month and 1-year follow-up. Results: The success rate for LBBP-CRT and BVP-aCRT was 98.00% and 91.07 %. Fused LBBP had the greatest reduced QRS duration compared to BVP-aCRT (102.61±9.66ms vs 126.54±11.67ms, P<0.001). Higher absolute LVEF and ΔLVEF was also achieved in LBBP-CRT than BVP-aCRT at 6-month (P=0.008,P=0.020) and 1-year follow-up (P=0.021,P=0.015). There was no significant difference in response rate between two groups while higher super-response rate was observed in LBBP-CRT as compared to BVP-aCRT at 6-month(53.06% vs 36.59%, p=0.016) and 12-month(61.22% vs 39.22%, p=0.028) during follow-up. The pacing threshold was lower in LBBP-CRT at implant and during 1-year follow-up(both p<0.001). Procedure-related complications and adverse clinical outcomes including heart failure hospitalization and mortality were not significantly different in 2 groups. Conclusions: The feasibility and efficacy of LBBP-CRT demonstrated better electromechanical resynchronization and higher clinical and echocardiographic response, especially higher super-response than BVP-aCRT in HFrEF with LBBB.