Remarkable response to cardiac resynchronization therapy via left bundle branch pacing in patients with true left bundle branch block

Abstract

Background: Left bundle branch pacing (LBBP) has been suggested as an alternative means to deliver cardiac resynchronization therapy (CRT). Hypothesis: LBBP may deliver resynchronization therapy along with an advantage over traditional biventricular (BiV) pacing in clinical outcomes. Methods: Heart failure patients who presented LBBB morphology according to Strauss's criteria and received successful CRT procedure were enrolled in the present study. Propensity score matching was applied to match patients into LBBP-CRT group and BiV-CRT group. Then, the electrographic data, the echocardiographic data and New York heart association (NYHA) class were compared between the groups. Results: Twenty-one patients with successful LBBP procedure and another 21 matched patients with successful BiV-CRT procedure were finally enrolled in the study. The QRS duration (QRSd) was narrowed from 167.7 ± 14.9 ms to 111.7 ± 12.3 ms (P < .0001) in the LBBP-CRT group and from 163.6 ± 13.8 ms to 130.1 ± 14.0 ms (P < .0001) in the BiV-CRT group. A trend toward better left ventricular ejection fraction (LVEF) was recorded in the LBBP-CRT group (50.9 ± 10.7% vs 44.4 ± 13.3%, P = .12) compared to that in the BiV-CRT group at the 6-month follow-up. A trend toward better echocardiographic response was documented in patients receiving LBBP-CRT procedure (90.5% vs 80.9%, P = .43) and more super CRT response was documented in the LBBP-CRT group (80.9% vs 57.1%, P = .09) compared to that in the BiV-CRT group. Conclusions: LBBP-CRT can dramatically improve the electrical synchrony in heart failure patients with LBBB. Meanwhile, compared with the traditional BiV-CRT, it has Jincun Guo and Linlin Li contributed equally to this work.

Left bundle branch pacing for cardiac resynchronization therapy: A systematic literature review and meta‐analysis

“…Of all six studies, two were single‐arm studies and the remaining four were comparative studies. Each patient had received guideline‐directed medical therapy before undergoing the procedure in the three studies, 11–13 and most of patients received that in the other studies 10,14,15 . All studies focused on CRT candidates with LBBB and HF who underwent permanent LBBP implantation, including primary implantation, 10,12,13,15 unsuccessful LV lead placement 12 and failure to achieve acceptable HBP parameters 11,14 .…”

“…All studies focused on CRT candidates with LBBB and HF who underwent permanent LBBP implantation, including primary implantation, 10,12,13,15 unsuccessful LV lead placement 12 and failure to achieve acceptable HBP parameters 11,14 . In brief, there are two methods 16 to identify the location for LBBP lead placement in six studies: the single lead method 10,12–15 and the dual lead method 11 . After confirming the initial site for LBBP the lead is then advanced deep into the septum to achieve left conduction system capture (Figure 2).…”

“…Of these, 24 studies were excluded due to abstract/review article, case report, and no revelent outcome. Altogether, the remaining six studies [10][11][12][13][14][15] comprising 174 patients were included in the analysis.…”

“…Each patient had received guidelinedirected medical therapy before undergoing the procedure in the three studies, [11][12][13] and most of patients received that in the other studies. 10,14,15 All studies focused on CRT candidates with LBBB and HF who underwent permanent LBBP implantation, including primary implantation, 10,12,13,15 unsuccessful LV lead placement 12 and failure to achieve acceptable HBP parameters. 11,14 In brief, there are two methods 16 to identify the location for LBBP lead placement in six studies: the single lead method 10,[12][13][14][15] and the dual lead method.…”

The year in cardiovascular medicine 2020: arrhythmias

“…Three studies comprising a total of 116 patients with LBBAP, 49 with HBP, and 75 with BVP consistently showed a larger reduction in QRS-complex (QRS) duration in combination with a larger increase in LV ejection fraction. 45,47,48 Salden et al 44 compared the acute hemodynamic and electrophysiological effects of 'LV septum pacing' with that of BVP and HBP. The three pacing modes were comparable with regards to increase in LVdP/dtmax, whilst HBP and LV septum pacing tended to provide better electrical resynchronization.…”