Complications of left bundle branch area pacing compared with biventricular pacing in candidates for resynchronization therapy: Results of a propensity score-matched analysis from a multicenter registry

Pietro Palmisano; Gabriele Dell'Era; Federico Guerra; Ernesto Ammendola; Matteo Ziacchi; Mattia Laffi; Paolo Donateo; Alessandro Guido; Chiara Ghiglieno; Antonio Parlavecchio; Antonio Dello Russo; Gerardo Nigro; Mauro Biffi; Germano Gaggioli; Jacopo Senes; Giuseppe Patti; Michele Accogli; Giovanni Coluccia

doi:10.1016/j.hrthm.2024.02.053

Complications of left bundle branch area pacing compared with biventricular pacing in candidates for resynchronization therapy: Results of a propensity score-matched analysis from a multicenter registry

Heart Rhythm. 2024 Feb 28:S1547-5271(24)00225-X. doi: 10.1016/j.hrthm.2024.02.053. Online ahead of print.

Authors

Pietro Palmisano¹, Gabriele Dell'Era², Federico Guerra³, Ernesto Ammendola⁴, Matteo Ziacchi⁵, Mattia Laffi⁶, Paolo Donateo⁷, Alessandro Guido⁸, Chiara Ghiglieno², Antonio Parlavecchio⁹, Antonio Dello Russo³, Gerardo Nigro⁴, Mauro Biffi⁵, Germano Gaggioli⁶, Jacopo Senes⁷, Giuseppe Patti², Michele Accogli⁸, Giovanni Coluccia⁸

Affiliations

¹ Cardiology Unit, "Card. G. Panico" Hospital, Tricase, Italy. Electronic address: dr.palmisano@libero.it.
² Division of Cardiology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
³ Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Umberto I - Lancisi - Salesi," Ancona, Italy.
⁴ Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
⁵ Istituto di Cardiologia, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.
⁶ Divisione Cardiologia, Ospedale Villa Scassi, Genova ASL 3, Genova, Italy.
⁷ Department of Cardiology, Arrhythmology Center, ASL 4 Chiavarese, Lavagna, Italy.
⁸ Cardiology Unit, "Card. G. Panico" Hospital, Tricase, Italy.
⁹ Cardiology Unit, "Card. G. Panico" Hospital, Tricase, Italy; Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.

PMID: 38428448
DOI: 10.1016/j.hrthm.2024.02.053

Abstract

Background: Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is a well-established therapy in patients with reduced left ventricular ejection fraction, heart failure, and left bundle branch block. Left bundle branch area pacing (LBBAP) has recently been shown to be a feasible and effective alternative to BVP. Comparative data on the risk of complications between LBBAP and BVP among patients undergoing CRT are lacking.

Objective: The aim of this study was to compare the long-term risk of procedure-related complications between LBBAP and BVP in a cohort of patients undergoing CRT.

Methods: This prospective, multicenter, observational study enrolled 668 consecutive patients (mean age 71.2 ± 10.0 years; 52.2% male; 59.4% with New York Heart Association class III-IV heart failure symptoms) with left ventricular ejection fraction 33.4% ± 4.3% who underwent BVP (n = 561) or LBBAP (n = 107) for a class I or II indication for CRT. Propensity score matching for baseline characteristics yielded 93 matched pairs. The rate and nature of intraprocedural and long-term post-procedural complications occurring during follow-up were prospectively collected and compared between the 2 groups.

Results: During a mean follow-up of 18 months, procedure-related complications were observed in 16 patients: 12 in BVP (12.9%) and 4 in LBBAP (4.3%) (P = .036). Compared with patients who underwent LBBAP, those who underwent BVP showed a lower complication-free survival (P = .032). In multivariate analysis, BVP resulted an independent predictive factor associated with a higher risk of complications (hazard ratio 3.234; P = .042). Complications related to the coronary sinus lead were most frequently observed in patients who underwent BVP (50.0% of all complications).

Conclusion: LBBAP was associated with a lower long-term risk of device-related complications compared with BVP in patients with an indication for CRT.

Keywords: Biventricular pacing; Cardiac resynchronization therapy; Complications; Conduction system pacing; Coronary sinus lead; Lead-related complications; Left bundle branch area pacing.