The Lead Episode 12: A Discussion of the Comparison of Left Bundle-Branch Area Pacing to Biventricular Pacing in Candidates for Resynchronization Therapy-Journal of the American College of Cardiology

Journal of the American College of Cardiology

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Left bundle branch area pacing (LBBAP) has been shown to be a safe and effective alternative to biventricular pacing (BVP) in patients requiring cardiac resynchronization therapy (CRT). This observational study compared the clinical outcomes between LBBAP and BVP in a large cohort of patients with reduced left ventricular ejection fraction (LVEF) who underwent CRT. The primary outcome of all-cause mortality or heart failure hospitalization (HFH) was significantly lower in the LBBAP group compared to the BVP group. LBBAP also resulted in a greater reduction in HFH compared to BVP. In patients with left bundle branch block (LBBB), LBBAP was associated with a greater reduction in the primary outcome of death or HFH compared to BVP. Additionally, LBBAP was found to result in a greater narrowing of QRS duration and improvements in functional class compared to BVP. Echocardiographic outcomes showed that LBBAP was associated with higher rates of echocardiographic response and hyper response, as well as improvements in left ventricular ejection fraction. Overall, these findings support the use of LBBAP as a reasonable alternative to BVP for patients requiring CRT. Large, randomized trials are needed to further compare the two pacing modalities and confirm these results.

Keywords

Left bundle branch area pacing

LBBAP

biventricular pacing

BVP

cardiac resynchronization therapy

CRT

left ventricular ejection fraction

LVEF

heart failure hospitalization

HFH