Effects of adaptive left bundle branch-optimized cardiac resynchronization therapy: a single centre experience

• Published in: BMC cardiovascular disorders Vol. 22; no. 1; p. 360
• Main Authors: Feng, Xiang-Fei, Yang, Ling-Chao, Zhao, Yan, Yu, Yi-Chi, Liu, Bo, Li, Yi-Gang
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06.08.2022; BioMed Central; BMC
• Subjects: Algorithms; Cardiac patients; Cardiac resynchronization therapy; Cardiac Resynchronization Therapy - adverse effects; Care and treatment; Congestive heart failure; Electrocardiography - methods; Heart block; Heart Conduction System; Heart failure; Heart Failure - diagnosis; Heart Failure - therapy; Humans; Ischaemic cardiomyopathy; Left bundle branch area pacing; Left bundle branch block; Morphology; Patient outcomes; Patients; Physiology; Prevention; Pulmonary arteries; Risk factors; Scars; Statistical analysis; Treatment Outcome; Ventricular Function, Left; China; United States > US; Heart failure; Ischaemic cardiomyopathy; Left bundle branch block; Cardiac resynchronization therapy; Left bundle branch area pacing
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-022-02742-2

Adaptive cardiac resynchronization therapy (aCRT) is associated with improved clinical outcomes. Left bundle branch area pacing (LBBAP) has shown encouraging results as an alternative option for aCRT. A technique that can be accomplished effectively using LBBAP combined with coronary venous pacing (LOT-aCRT). We aimed to assess the feasibility and outcomes of LOT-aCRT. LOT-aCRT, capable of providing two pacing modes, LBBAP alone or LBBAP combined with LV pacing, was attempted in patients with CRT indications. Patients were divided into two groups: those with LBBAP and LV pacing (LOT-aCRT) and those with conventional biventricular pacing (BVP-aCRT). A total of 21 patients were enrolled in the study (10 in the LOT-aCRT group, 11 in the BVP-aCRT group). In the LOT-aCRT group, the QRS duration (QRSd) via BVP was narrowed from 158.0 ± 13.0 ms at baseline to 132.0 ± 4.5 ms (P = 0.019) during the procedure, and further narrowed to 123.0 ± 5.7 ms (P < 0.01) via LBBAP. After the procedure, when LOT-aCRT implanted and worked, QRSd was further changed to 121.0 ± 3.8 ms, but the change was not significant (P > 0.05). In the BVP-aCRT group, BVP resulted in a significant reduction in the QRSd from 176.7 ± 19.7 ms at baseline to 133.3 ± 8.2 ms (P = 0.011). However, compared with LOT-aCRT, BVP has no advantage in reducing QRSd and the difference was statistically significant (P < 0.01). During 9 months of follow-up, patients in both groups showed improvements in the LVEF and NT-proBNP levels (all P < 0.01). However, compared with BVP-aCRT, LOT-aCRT showed more significant changes in these parameters (P < 0.01). The study demonstrates that LOT-aCRT is clinically feasible in patients with systolic heart failure and LBBB. LOT-aCRT was associated with significant narrowing of the QRSd and improvement in LV function.