Comparisons of long-term clinical outcomes with left bundle branch pacing, left ventricular septal pacing, and biventricular pacing for cardiac resynchronization therapy

Haojie Zhu; Chaotong Qin; Anjie Du; Qian Wang; Chen He; Fengwei Zou; Xiaofei Li; Jin Tao; Chuangshi Wang; Zhimin Liu; Siyuan Xue; Jiaxin Zeng; Zhiyong Qian; Yao Wang; Xiaofeng Hou; Kenneth A Ellenbogen; Michael R Gold; Yan Yao; Jiangang Zou; Xiaohan Fan

doi:10.1016/j.hrthm.2024.03.007

Comparisons of long-term clinical outcomes with left bundle branch pacing, left ventricular septal pacing, and biventricular pacing for cardiac resynchronization therapy

Heart Rhythm. 2024 Mar 9:S1547-5271(24)00242-X. doi: 10.1016/j.hrthm.2024.03.007. Online ahead of print.

Authors

Haojie Zhu¹, Chaotong Qin², Anjie Du², Qian Wang¹, Chen He¹, Fengwei Zou³, Xiaofei Li¹, Jin Tao⁴, Chuangshi Wang⁵, Zhimin Liu¹, Siyuan Xue², Jiaxin Zeng², Zhiyong Qian², Yao Wang², Xiaofeng Hou², Kenneth A Ellenbogen⁶, Michael R Gold⁷, Yan Yao¹, Jiangang Zou⁸, Xiaohan Fan⁹

Affiliations

¹ Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
² Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
³ Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
⁴ Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁵ Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
⁶ Department of Cardiology, VCU School of Medicine, Richmond, Virginia.
⁷ Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
⁸ Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China.
⁹ Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China. Electronic address: fanxiaohan@fuwaihospital.org.

PMID: 38461922
DOI: 10.1016/j.hrthm.2024.03.007

Abstract

Background: Left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) are referred to as left bundle branch area pacing.

Objective: This study investigated whether long-term clinical outcomes differ in patients undergoing LBBP, LVSP, and biventricular pacing (BiVP) for cardiac resynchronization therapy (CRT).

Methods: Consecutive patients with reduced left ventricular ejection fraction (LVEF <50%) undergoing CRT were prospectively enrolled if they underwent successful LBBP, LVSP, or BiVP. The primary composite end point was all-cause mortality or heart failure hospitalization. Secondary end points included all-cause mortality, heart failure hospitalization, and echocardiographic measures of reverse remodeling.

Results: A total of 259 patients (68 LBBP, 38 LVSP, and 153 BiVP) were observed for a mean duration of 28.8 ± 15.8 months. LBBP was associated with a significantly reduced risk of the primary end point by 78% compared with both BiVP (7.4% vs 41.2%; adjusted hazard ratio [aHR], 0.22 [0.08-0.57]; P = .002) and LVSP (7.4% vs 47.4%; aHR, 0.22 [0.08-0.63]; P = .004]. The adjusted risk of all-cause mortality was significantly higher in LVSP than in BiVP (31.6% vs 7.2%; aHR, 3.19 [1.38-7.39]; P = .007) but comparable between LBBP and BiVP (2.9% vs 7.2%; aHR, 0.33 [0.07-1.52], P = .155). Propensity score adjustment also obtained similar results. LBBP showed a higher rate of echocardiographic response (ΔLVEF ≥10%: 60.0% vs 36.2% vs 16.1%; P < .001) than BiVP or LVSP.

Conclusion: LBBP yielded long-term clinical outcomes superior to those of BiVP and LVSP. The role of LVSP for CRT needs to be reevaluated because of its high mortality risk.

Keywords: Biventricular pacing; Heart failure treatment; Left bundle branch area pacing; Left bundle branch pacing; Left ventricular septal pacing.