The fastest-growing conduction system pacing method that can treat intrinsic left bundle branch block (LBBB) is called left bundle branch pacing (LBBP). As a result, it may be the best substitute for cardiac resynchronization therapy (CRT) using biventricular pacing (BiVP). For a study, researchers sought to compare the effectiveness of LBBP-CRT and BiVP-CRT in treating patients with heart failure and lower left ventricular ejection fraction (LVEF).
Patients with nonischemic cardiomyopathy and LBBB were being studied in a prospective, randomized study with a 6-month anticipated follow-up. If LBBP or BiVP failed, crossovers were permitted. The difference in LVEF improvement between the two groups served as the main outcome. Among the secondary objectives were the changes in echocardiographic measures, NT-proBNP, New York Heart Association functional class, 6-minute walk distance, QRS duration, and CRT response.
Twenty male patients with a mean age of 63.7 years and an LVEF of 29.7%± 5.6% were included in the study’s 40 total participants. A 10% LBBP-CRT and a 20% BiVP-CRT crossover rate were recorded. All patients finished their follow-up. At 6 months following LBBP-CRT compared to BiVP-CRT, the LVEF substantially improved (mean difference: 5.6%; 95% CI: 0.3-10.9; P = 0.039) according to an intention-to-treat analysis. Along with similar changes in New York Heart Association functional class, 6-minute walk distance, QRS duration, and rates of CRT response, LBBP-CRT appeared to have greater reductions in left ventricular end-systolic volume (-24.97 mL; 95% CI: -49.58 to -0.36 mL), NT-proBNP (-1,071.80 pg/mL; 95% CI: -2,099.40 to −44.20 pg/mL).
In patients with heart failure with nonischemic cardiomyopathy and LBBB, LBBP-CRT showed a larger improvement in LVEF than BiVP-CRT.
Reference: jacc.org/doi/10.1016/j.jacc.2022.07.019
