Left bundle branch pacing-CRT better for patients with heart failure and LVEF

Left bundle branch pacing, a most rapidly growing conduction system pacing technique, is capable of correcting intrinsic left bundle branch block. It could be an optimal alternative to CRT with biventricular pacing. Yao Wang, Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China, and colleagues aimed to compare the effectiveness of LBBP-CRT with BiVP-CRT in patients with heart failure reduced left ventricular ejection fraction (LVEF) in a prospective, randomized trial.

The trial included patients with nonischemic cardiomyopathy and LBBB having a 6-month preplanned follow-up. In case of failure of LBBP or BiVP, crossovers were allowed.

The difference in LVEF improvement between the two groups was the primary endpoint. The secondary endpoints were changes in N-terminal pro–B-type natriuretic peptide (NT-proBNP), echocardiographic measurements, 6-minute walk distance, New York Heart Association functional class, CRT response, and QRS duration. A total of 40 consecutive patients comprising 20 males (mean age 63.7 years, LVEF 29.7% ± 5.6%) were included in the study.

Following were the study's main findings:

• Crossovers occurred in 10% of LBBP-CRT and 20% of BiVP-CRT.
• All patients completed follow-up. Intention-to-treat analysis showed significantly more LVEF improvement six months after LBBP-CRT than BiVP-CRT (mean difference: 5.6%).
• LBBP-CRT also appeared to have more significant reductions in left ventricular end-systolic volume (−24.97 mL) and NT-proBNP (−1,071.80 pg/mL), and comparable changes in New York Heart Association functional class, QRS duration, 6-minute walk distance, and rates of CRT response compared with BiVP-CRT.

The researchers conclude, "Left bundle branch pacing cardiac resynchronization therapy trumped biventricular pacing for improved surrogate markers of heart function in heart failure with nonischemic cardiomyopathy and left bundle branch block."

Reference:

The study, "Randomized Trial of Left Bundle Branch vs Biventricular Pacing for Cardiac Resynchronization Therapy," was published in the Journal of the American College of Cardiology (JACC).