Cardiac resynchronization therapy via left bundle branch pacing vs. optimized biventricular pacing with adaptive algorithm in heart failure with left bundle branch block: a prospective, multi-centre, observational study.
Cardiac resynchronization therapy via left bundle branch pacing vs. optimized biventricular pacing with adaptive algorithm in heart failure with left bundle branch block: a prospective, multi-centre, observational study.
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DOI：
10.1093/europace/euab249
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发表时间：
2022-05-03
期刊：
影响因子：
6.1
通讯作者：
Ge, Junbo
中科院分区：
文献类型：
--
作者：
Chen, Xueying;Ye, Yang;Wang, Zhongkai;Jin, Qinchun;Qiu, Zhaohui;Wang, Jingfeng;Qin, Shengmei;Bai, Jin;Wang, Wei;Liang, Yixiu;Chen, Haiyan;Sheng, Xia;Gao, Feng;Zhao, Xianxian;Fu, Guosheng;Ellenbogen, Kenneth A.;Su, Yangang;Ge, Junbo
关键词：
本研究旨在评价经左束支分支起搏（LBBP-CRT）与自适应优化双心室起搏（BVP-aCRT）治疗左室射血分数≤35%（HFrEF）降低伴左束支分支传导阻滞（LBBB）的心力衰竭的可行性和有效性。在4个中心以非随机方式前瞻性入组了100例接受CRT的HFrEF和LBBB患者，并将其分为两组（LBBP-CRT，n = 49; BVP-aCRT，n = 51）。在基线以及6个月和1年随访期间访问植入物特征和超声心动图参数。LBBP-CRT和BVP-aCRT的成功率分别为98.00%和91.07%。融合LBBP与BVP-aCRT相比，QRS时限缩短最多（126.54 ± 11.67 vs. 102.61 ± 9.66 ms，P < 0.001）。6个月时，LBBP-CRT的绝对左心室射血分数（LVEF）和△LVEF也高于BVP-aCRT（47.58 ± 12.02% vs41.24 ± 10.56%，P = 0.008; 18.52 ± 13.19% vs. 12.89 ± 9.73%，P = 0.020）和1年随访（49.10 ± 10.43% vs. 43.62 ± 11.33%，P = 0.021; 20.90 ± 11.80% vs. 15.20 ± 9.98%，P = 0.015，P = 0.015）。两组间的有效率无显著差异，但随访期间6个月（53.06% vs. 36.59%，P = 0.016）和12个月（61.22% vs. 39.22%，P = 0.028）时，LBBP-CRT的超反应率高于BVP-aCRT。LBBP-CRT在植入时和1年随访期间的起搏阈值较低（均P < 0.001）。两组手术相关并发症和不良临床结局（包括心力衰竭、住院和死亡率）无显著差异。LBBP-CRT治疗HFrEF合并LBBB的可行性和有效性表明，LBBP-CRT具有更好的电机械稳定性和更高的临床和超声心动图反应，特别是更高的超反应。
The purpose of our study was to evaluate the feasibility and efficacy of cardiac resynchronization therapy (CRT) via left bundle branch pacing (LBBP-CRT) compared with optimized biventricular pacing (BVP) with adaptive algorithm (BVP-aCRT) in heart failure with reduced left ventricular ejection fraction ≤35% (HFrEF) and left bundle branch block (LBBB). One hundred patients with HFrEF and LBBB undergoing CRT were prospectively enrolled in a non-randomized fashion and divided into two groups (LBBP-CRT, n = 49; BVP-aCRT, n = 51) in four centres. Implant characteristics and echocardiographic parameters were accessed at baseline and during 6-month and 1-year follow-up. The success rate for LBBP-CRT and BVP-aCRT was 98.00% and 91.07%. Fused LBBP had the greatest reduced QRS duration compared to BVP-aCRT (126.54 ± 11.67 vs. 102.61 ± 9.66 ms, P < 0.001). Higher absolute left ventricular ejection fraction (LVEF) and △LVEF was also achieved in LBBP-CRT than BVP-aCRT at 6-month (47.58 ± 12.02% vs. 41.24 ± 10.56%, P = 0.008; 18.52 ± 13.19% vs. 12.89 ± 9.73%, P = 0.020) and 1-year follow-up (49.10 ± 10.43% vs. 43.62 ± 11.33%, P = 0.021; 20.90 ± 11.80% vs. 15.20 ± 9.98%, P = 0.015, P = 0.015). There was no significant difference in response rate between two groups while higher super-response rate was observed in LBBP-CRT as compared to BVP-aCRT at 6 months (53.06% vs. 36.59%, P = 0.016) and 12 months (61.22% vs. 39.22%, P = 0.028) during follow-up. The pacing threshold was lower in LBBP-CRT at implant and during 1-year follow-up (both P < 0.001). Procedure-related complications and adverse clinical outcomes including heart failure hospitalization and mortality were not significantly different in two groups. The feasibility and efficacy of LBBP-CRT demonstrated better electromechanical resynchronization and higher clinical and echocardiographic response, especially higher super-response than BVP-aCRT in HFrEF with LBBB.
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