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Left Bundle Branch Area Pacing versus Biventricular Pacing for Cardiac Resynchronization Therapy on Morbidity and Mortality

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Abstract

Background

Left bundle branch area pacing (LBBAP) has emerged as an alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT). We aimed to compare the morbidity and mortality associated with LBBAP versus BVP in patients undergoing CRT implantation.

Methods

Consecutive patients who received CRT from two high-volume implantation centers were retrospectively recruited. The primary endpoint was a composite of all-cause death and heart failure hospitalization, and the secondary endpoint was all-cause death.

Results

A total of 491 patients receiving CRT (154 via LBBAP and 337 via BVP) were included, with a median follow-up of 31 months. The primary endpoint was reached by 21 (13.6%) patients in the LBBAP group, as compared with 74 (22.0%) patients in the BVP group [hazard ratio (HR) 0.70, 95% confidence interval (CI) 0.43–1.14, P = 0.15]. There were 10 (6.5%) deaths in the LBBAP group, as compared with 31 (9.2%) in the BVP group (HR 0.91, 95% CI 0.44–1.86, P = 0.79). No significant difference was observed in the risk of either the primary or secondary endpoint between LBBAP and BVP after multivariate Cox regression (HR 0.74, 95% CI 0.45–1.23, P = 0.24, and HR 0.77, 95% CI 0.36–1.67, P = 0.51, respectively) or propensity score matching (HR 0.72, 95% CI 0.41–1.29, P = 0.28, and HR 0.69, 95% CI 0.29–1.65, P = 0.40, respectively).

Conclusion

LBBAP was associated with a comparable effect on morbidity and mortality relative to BVP in patients with indications for CRT.

Highlights

Left bundle branch area pacing (LBBAP) was associated with a comparable effect on morbidity and mortality relative to biventricular pacing (BVP) in patients with indications for cardiac resynchronization therapy (CRT).

LBBAP may serve as a promising alternative to BVP for CRT to improve morbidity and mortality among heart failure patients.

Randomized controlled clinical trials with adequate sample size are justified to confirm these findings.

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Data Availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Funding

This research is supported by the Science and Technology Commission of Shanghai Municipality (No. 19DZ1931002) and Shanghai Clinical Research Center for Interventional Medicine (No. 19MC1910300).

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Authors and Affiliations

Authors

Contributions

All authors contributed to the study conception and design. YL, ZX and XL designed the study; XL, JW, XG, MG, and XC performed the procedure; ZX, ZY, SY, LZ, ML, LP, and XL collected the data; YL, ZX, HL analyzed the data; and YS, WH, and JB performed critical revision and final approval of the study. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Yangang Su or Wei Hua.

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Ethics Approval

The study complied with the Declaration of Helsinki and was approved by the local ethics committee (registration number B2022-242R).

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Written informed consent was obtained from all study participants.

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Written informed consent was obtained from all study participants.

Conflict of Interest

Hongyang Lu is an employee of Medtronic. All other authors report that they have no relationships to disclose relevant to the contents of this paper.

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Liang, Y., Xiao, Z., Liu, X. et al. Left Bundle Branch Area Pacing versus Biventricular Pacing for Cardiac Resynchronization Therapy on Morbidity and Mortality. Cardiovasc Drugs Ther (2022). https://doi.org/10.1007/s10557-022-07410-3

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