Marek Jastrzębski1, Paweł Moskal2, Wim Huybrechts3, Karol Curila4, Praveen Sreekumar5, Leonard M Rademakers6, Shunmuga Sundaram Ponnusamy7, Bengt Herweg8, Parikshit S Sharma9, Agnieszka Bednarek2, Marek Rajzer2, Pugazhendhi Vijayaraman10. 1. First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland. Electronic address: mcjastrz@cyf-kr.edu.pl. 2. First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland. 3. Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium. 4. Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic. 5. Electrophysiology Unit, Department of Cardiology, Aster Medcity, Kochi, Kerala, India. 6. Department of Cardiology, Catharina Ziekenhuis, Eindhoven, The Netherlands. 7. Department of Cardiology, Velammal Medical College Hospital and Research Institute, Velammal Village, Madurai, Tamil Nadu, India. 8. Division of Cardiology, University of South Florida, Tampa, Florida. 9. Rush University Medical Center, Chicago, Illinois. 10. Geisinger Heart Institute, Wilkes-Barre, Pennsylvania.
Abstract
BACKGROUND: Cardiac resynchronization therapy (CRT) based on the conventional biventricular pacing (BiV-CRT) technique sometimes results in broad QRS complex and suboptimal response. OBJECTIVE: We aimed to assess the feasibility and outcomes of CRT based on left bundle branch area pacing (LBBAP, in lieu of the right ventricular lead) combined with coronary venous left ventricular pacing in an international multicenter study. METHODS: LBBAP-optimized CRT (LOT-CRT) was attempted in nonconsecutive patients with CRT indications. Addition of the LBBA (or coronary venous) lead was at the discretion of the implanting physician, who was guided by suboptimal paced QRS complex, and/or on clinical grounds. RESULTS: LOT-CRT was successful in 91 of 112 patients (81%). The baseline characteristics were as follows: mean age 70 ± 11 years, female 22 (20%), left ventricular ejection fraction 28.7% ± 9.8%, left ventricular end-diastolic diameter 62 ± 9 mm, N-terminal pro-B-type natriuretic peptide level 5821 ± 8193 pg/mL, left bundle branch block 47 (42%), nonspecific intraventricular conduction delay 25 (22%), right ventricular pacing 26 (23%), and right bundle branch block 14 (12%). The procedure characteristics were as follows: mean fluoroscopy time 27.3 ± 22 minutes, LBBAP capture threshold 0.8 ± 0.5 V @ 0.5 ms, and R-wave amplitude 10 mV. LOT-CRT resulted in significantly greater narrowing of QRS complex from 182 ± 25 ms at baseline to 144 ± 22 ms (P < .0001) than did BiV-CRT (170 ± 30 ms; P < .0001) and LBBAP (162 ± 23 ms; P < .0001). At follow-up of ≥3 months, the ejection fraction improved to 37% ± 12%, left ventricular end-diastolic diameter decreased to 59 ± 9 mm, N-terminal pro-B-type natriuretic peptide level decreased to 2514 ± 3537 pg/mL, pacing parameters were stable, and clinical improvement was noted in 76% of patients (New York Heart Association class 2.9 vs 1.9). CONCLUSION: LOT-CRT is feasible and safe and provides greater electrical resynchronization as compared with BiV-CRT and could be an alternative, especially when only suboptimal electrical resynchronization is obtained with BiV-CRT. Randomized controlled trials comparing LOT-CRT and BiV-CRT are needed.
BACKGROUND: Cardiac resynchronization therapy (CRT) based on the conventional biventricular pacing (BiV-CRT) technique sometimes results in broad QRS complex and suboptimal response. OBJECTIVE: We aimed to assess the feasibility and outcomes of CRT based on left bundle branch area pacing (LBBAP, in lieu of the right ventricular lead) combined with coronary venous left ventricular pacing in an international multicenter study. METHODS: LBBAP-optimized CRT (LOT-CRT) was attempted in nonconsecutive patients with CRT indications. Addition of the LBBA (or coronary venous) lead was at the discretion of the implanting physician, who was guided by suboptimal paced QRS complex, and/or on clinical grounds. RESULTS: LOT-CRT was successful in 91 of 112 patients (81%). The baseline characteristics were as follows: mean age 70 ± 11 years, female 22 (20%), left ventricular ejection fraction 28.7% ± 9.8%, left ventricular end-diastolic diameter 62 ± 9 mm, N-terminal pro-B-type natriuretic peptide level 5821 ± 8193 pg/mL, left bundle branch block 47 (42%), nonspecific intraventricular conduction delay 25 (22%), right ventricular pacing 26 (23%), and right bundle branch block 14 (12%). The procedure characteristics were as follows: mean fluoroscopy time 27.3 ± 22 minutes, LBBAP capture threshold 0.8 ± 0.5 V @ 0.5 ms, and R-wave amplitude 10 mV. LOT-CRT resulted in significantly greater narrowing of QRS complex from 182 ± 25 ms at baseline to 144 ± 22 ms (P < .0001) than did BiV-CRT (170 ± 30 ms; P < .0001) and LBBAP (162 ± 23 ms; P < .0001). At follow-up of ≥3 months, the ejection fraction improved to 37% ± 12%, left ventricular end-diastolic diameter decreased to 59 ± 9 mm, N-terminal pro-B-type natriuretic peptide level decreased to 2514 ± 3537 pg/mL, pacing parameters were stable, and clinical improvement was noted in 76% of patients (New York Heart Association class 2.9 vs 1.9). CONCLUSION: LOT-CRT is feasible and safe and provides greater electrical resynchronization as compared with BiV-CRT and could be an alternative, especially when only suboptimal electrical resynchronization is obtained with BiV-CRT. Randomized controlled trials comparing LOT-CRT and BiV-CRT are needed.
Authors: Maciej Sterliński; Joanna Zakrzewska-Koperska; Aleksander Maciąg; Adam Sokal; Joaquin Osca-Asensi; Lingwei Wang; Vasiliki Spyropoulou; Baerbel Maus; Francesca Lemme; Osita Okafor; Berthold Stegemann; Richard Cornelussen; Francisco Leyva Journal: Front Cardiovasc Med Date: 2022-05-12
Authors: Pugazhendhi Vijayaraman; Oscar Cano; Shunmuga Sundaram Ponnusamy; Manuel Molina-Lerma; Joseph Y S Chan; Santosh K Padala; Parikshit S Sharma; Zachary I Whinnett; Bengt Herweg; Gaurav A Upadhyay; Faiz A Subzposh; Neil R Patel; Dominik A Beer; Agnieszka Bednarek; Grzegorz Kielbasa; Roderick Tung; Kenneth A Ellenbogen; Marek Jastrzebski Journal: Heart Rhythm O2 Date: 2022-05-14