Left Bundle Branch Area Pacing Compared to Biventricular Pacing for Cardiac Resynchronization Therapy in Patients with Left Ventricular Ejection Fraction ≤50%: Results from the International Collaborative LBBAP Study (I-CLAS)

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00216208%3A11120%2F25%3A43928377" target="_blank" >RIV/00216208:11120/25:43928377 - isvavai.cz</a>

Výsledek na webu

<a href="https://doi.org/10.1016/j.hrthm.2025.04.005" target="_blank" >https://doi.org/10.1016/j.hrthm.2025.04.005</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1016/j.hrthm.2025.04.005" target="_blank" >10.1016/j.hrthm.2025.04.005</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Left Bundle Branch Area Pacing Compared to Biventricular Pacing for Cardiac Resynchronization Therapy in Patients with Left Ventricular Ejection Fraction ≤50%: Results from the International Collaborative LBBAP Study (I-CLAS)

Popis výsledku v původním jazyce

BACKGROUND: Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is an established treatment of heart failure with reduced ejection fraction and wide QRS. Left bundle branch area pacing (LBBAP) has emerged as a physiologic alternative by directly engaging the His-Purkinje system, potentially improving electrical resynchronization and clinical outcomes. OBJECTIVE: The aim of the study was to compare the clinical outcomes between BVP and LBBAP in patients with left ventricular ejection fraction (LVEF) &lt;=50% undergoing CRT. METHODS: This multicenter observational study included patients with LVEF &lt;=50% receiving CRT with either LBBAP or BVP at 18 centers from January 2018 to June 2023. The primary outcome was a composite of all-cause mortality or first heart failure hospitalization (HFH). Secondary outcomes included separate analyses of HFH and all-cause mortality. Propensity score matching was used to balance baseline characteristics. Kaplan-Meier curves, Cox proportional hazards models, and competing risk analyses were performed. RESULTS: A total of 2579 patients were included (BVP, 1118; LBBAP, 1461). In the propensity score-matched cohort (BVP, 780; LBBAP, 780), LBBAP demonstrated shorter paced QRS duration (129 +- 19 ms vs 143 +- 22 ms; P &lt; .001). LBBAP was associated with a significantly lower risk of the composite primary outcome (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.66-0.98; P = .048) and reduced HFH (HR, 0.63; 95% CI, 0.49-0.82; P &lt; .001). No significant difference in all-cause mortality was observed (HR, 0.82; 95% CI, 0.63-1.07; P = .156). Procedural complications were lower with LBBAP (3.5% vs 6.5%, P = .004). CONCLUSION: LBBAP was associated with superior electrical resynchronization, fewer HFHs, and lower procedural complications compared with BVP in patients with LVEF &lt;50% requiring CRT. Randomized trials are needed to confirm long-term benefits.

Název v anglickém jazyce

Left Bundle Branch Area Pacing Compared to Biventricular Pacing for Cardiac Resynchronization Therapy in Patients with Left Ventricular Ejection Fraction ≤50%: Results from the International Collaborative LBBAP Study (I-CLAS)

Popis výsledku anglicky

BACKGROUND: Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is an established treatment of heart failure with reduced ejection fraction and wide QRS. Left bundle branch area pacing (LBBAP) has emerged as a physiologic alternative by directly engaging the His-Purkinje system, potentially improving electrical resynchronization and clinical outcomes. OBJECTIVE: The aim of the study was to compare the clinical outcomes between BVP and LBBAP in patients with left ventricular ejection fraction (LVEF) &lt;=50% undergoing CRT. METHODS: This multicenter observational study included patients with LVEF &lt;=50% receiving CRT with either LBBAP or BVP at 18 centers from January 2018 to June 2023. The primary outcome was a composite of all-cause mortality or first heart failure hospitalization (HFH). Secondary outcomes included separate analyses of HFH and all-cause mortality. Propensity score matching was used to balance baseline characteristics. Kaplan-Meier curves, Cox proportional hazards models, and competing risk analyses were performed. RESULTS: A total of 2579 patients were included (BVP, 1118; LBBAP, 1461). In the propensity score-matched cohort (BVP, 780; LBBAP, 780), LBBAP demonstrated shorter paced QRS duration (129 +- 19 ms vs 143 +- 22 ms; P &lt; .001). LBBAP was associated with a significantly lower risk of the composite primary outcome (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.66-0.98; P = .048) and reduced HFH (HR, 0.63; 95% CI, 0.49-0.82; P &lt; .001). No significant difference in all-cause mortality was observed (HR, 0.82; 95% CI, 0.63-1.07; P = .156). Procedural complications were lower with LBBAP (3.5% vs 6.5%, P = .004). CONCLUSION: LBBAP was associated with superior electrical resynchronization, fewer HFHs, and lower procedural complications compared with BVP in patients with LVEF &lt;50% requiring CRT. Randomized trials are needed to confirm long-term benefits.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30201 - Cardiac and Cardiovascular systems

Projekt

—

Návaznosti

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Rok uplatnění

2025

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Heart Rhythm

ISSN

1547-5271

e-ISSN

1556-3871

Svazek periodika

22

Číslo periodika v rámci svazku

8

Stát vydavatele periodika

US - Spojené státy americké

Počet stran výsledku

10

Strana od-do

2028-2037

Kód UT WoS článku

001544833200030

EID výsledku v databázi Scopus

2-s2.0-105003971506