Efficacy of Left Bundle Branch Area Pacing Versus Biventricular Pacing in Cardiac Resynchronization Therapy Patients: Select Site - Cohort Study.

BACKGROUND: Cardiac resynchronization therapy (CRT) is typically attempted with biventricular pacing. One-third of patients are non-responders. Left bundle branch area pacing (LBBAP) has been evaluated as an alternative means.

OBJECTIVE: To assess the feasibility and clinical response of permanent LBBAP as an alternative to biventricular pacing.

METHODS: Of 479 consecutive patients referred with heart failure (HF), 50 with biventricular pacing (BiV-CRT) and 51 with left bundle branch area pacing (LBBAP-CRT) were included in this analysis after study exclusions. Quality-of-Life (QoL) assessments; electrocardiogram and echocardiographic measurements; and New York Heart Association (NYHA) class were obtained at baseline and at 6-monthly Intervals.

RESULTS: There were no differences in baseline characteristics between groups (P=NS). Clinical outcomes such as left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), QoL and NYHA class were significantly improved for both pacing groups compared to baseline. LBBAP-CRT group showed greater improvement in LVEF at 6- (p=0.001) and 12-months (P=0.021), accompanied by greater reduction in LVESV (P=0.007). QRS <120 ms (baseline 160.82±21.35ms vs 161.08±24.48ms) was achieved in 30% in BiV-CRT vs 71% in LBBAP-CRT group (P=<0.001). Improvement in NYHA class (P=0.031) and QoL index was greater (P=0.014). Reduced HF admissions (P=0.003) and healthcare utilisation (P<0.05), and improved lead performance (p<0.001) were observed in LBBAP-CRT group.

CONCLUSIONS: LBBAP-CRT is a feasible and effective cardiac resynchronisation therapy. It results into a meaningful improvement in QoL and reduction in healthcare utilisation. This can be offered as an alternative to BiV-CRT or potentially as first-line therapy.