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Abstract
Left bundle branch area pacing (LBBAP) has developed in an effort to improve cardiac resynchronization therapy (CRT). We aimed to compare the long-term clinical outcomes between LBBAP and biventricular pacing (BIVP) in patients with heart failure (HF) and complete left bundle branch block (CLBBB). Consecutive patients with HF and CLBBB requiring CRT received either LBBAP or BIVP were recruited at the Second Affiliated Hospital of Nanchang University from February 2018 to May 2019. We assessed their implant parameters, electrocardiogram (ECG), clinical outcomes at implant and during follow-up at 1, 3, 6, 12, and 24 months. Forty-one patients recruited including 21 for LBBAP and 20 for BIVP. Mean follow-up duration was 23.71 ± 4.44 months. LBBAP produced lower pacing thresholds, shorter procedure time and fluoroscopy duration compared to BIVP. The QRS duration was significantly narrower after LBBAP than BIVP (129.29 ± 31.46 vs. 156.85 ± 26.37 ms, p = 0.005). Notably, both LBBAP and BIVP significantly improved LVEF, LVEDD, NYHA class, and BNP compared with baseline. However, LBBAP significantly lowered BNP compared with BIVP (416.69 ± 411.39 vs. 96.07 ± 788.71 pg/ml, p = 0.007) from baseline to 24-month follow-up. Moreover, patients who received LBBAP exhibited lower number of hospitalizations than those in the BIVP group (p = 0.019). In addition, we found that patients with moderately prolonged left ventricular activation time (LVAT) and QRS notching in limb leads in baseline ECG respond better to LBBAP for CLBBB correction. LBBAP might be a relative safe and effective resynchronization therapy and as a supplement to BIVP for patients with HF and CLBBB.
Highlights
Heart failure (HF) is a major public health issue with high morbidity and mortality, resulting in considerable financial and service burdens to the health system [1]
Our major findings were as follows: (1) Left bundle branch area pacing (LBBAP) is a feasible and safe approach for successful correction of complete left bundle branch block (CLBBB) in patients with HF and CLBBB; (2) The long-term follow-up revealed that LBBAP significantly improved LVEF and NYHA functional class and further lowered BNP level and LVEDD; (3) LBBAP significantly shortened QRS duration and exerted better cardiac electrical resynchronization to relieve symptoms of HF, compared with biventricular pacing (BIVP); and (4) In the LBBAP group, patients with moderately prolonged left ventricular activation time (LVAT) and QRS with a notch in the limb leads in preoperative ECG, may benefit more from CLBBB full correction
LBBAP significantly improved LVEF, LVEDD, BNP and NYHA class at 24-month follow-up compared with baseline, while it resulted in shorter QRS and lower BNP, than BIVP
Summary
Heart failure (HF) is a major public health issue with high morbidity and mortality, resulting in considerable financial and service burdens to the health system [1]. Selective LBBP (S-LBBP) only captures the LBB without myocardial capture, while nonselective LBBP (NSLBBP) captures both the LBB and the local myocardium [16] It is called LV septal endocardium pacing (LVSP) or deep septal pacing if only LV septal myocardium is captured [16]. Left bundle branch area pacing (LBBAP), with the lead implanted slightly distal to the His bundle and screwed deep in the LV septum ideally to capture LBB according to the ESC guidelines in 2021 [17], means LBBP or LVSP, without clear evidence for LBB capture [18]. Accumulating studies have shown that LBBAP can correct complete left bundle branch block (CLBBB), restore LV synchrony in HF patients, and improve cardiac function as well as symptoms in these patients, but the average period of follow-up for these studies was relatively short ranging from 6 to 12 months [15, 19, 20].
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