Left bundle branch pacing vs. biventricular pacing for cardiac resynchronization therapy in the long-term: a prospective, non-randomized, cohort study.

BACKGROUND

The classical instrumental treatment for heart failure(HF) is biventricular pacing (BiV-CRT); however, BiV-CRT exhibits a non-response rate as high as 30%. This study aimed to compare the feasibility and effectiveness of cardiac resynchronization therapy(CRT) via left bundle branch pacing(LBBP-CRT) and BiV-CRT in HF patients with left bundle branch block (LBBB). METHODS AND

RESULTS

This prospective, nonrandomized cohort study enrolled 140 patients who underwent CRT. Patients were divided into two groups according to pacing modality: LBBP-CRT or BiV-CRT, with a 1-year pre-planned follow-up. The success rates were 94.3% (66/70) for LBBP-CRT and 88.6% (62/70) for BiV-CRT. Compared to BiV-CRT, LBBP-CRT patients had greater pacing QRS duration(QRSd) reduction [Treatment effect (95%CI): -19.15 (-28.72, -9.59)], higher Left ventricular ejection fraction (LVEF) improvement [Treatment effect (95%CI): 2.89 (0.08, 5.71)] and better pacing parameters performance during 1-year follow-up. In a mean follow-up duration of 21.6 months, LBBP-CRT resulted in a lower risk of HF re-hospitalization [HR (95%CI): 0.250 (0.067–0.926)], while all-cause mortality was comparable between the two pacing groups.

CONCLUSIONS

LBBP-CRT demonstrated better electrical synchronization, higher echocardiographic response, and lower risk of HF re-hospitalization in patients with heart failure with reduced ejection fraction(HFrEF) and LBBB. REGISTRATION NUMBER: ChiCTR2000028726, Registration date: 2020-01-01.