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Left Bundle Branch Area Pacing: A Paradigm Shift in Cardiac Resynchronization Therapy
Session:
Sessão de Posters 30 - Terapia de Ressincronização Cardíaca
Speaker:
Diogo De Almeida Fernandes
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.6 Device Therapy - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Diogo De Almeida Fernandes; João André Ferreira; Patrícia Alves; Carolina Saleiro; Natália António; Luís Elvas; Lino Gonçalves
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>INTRODUCTION</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Cardiac resynchronization therapy (CRT) has a pivotal role in heart failure (HF) treatment. Left bundle branch area pacing (LBBAP) has shown promising results in improving LV function and outcomes. Our aim was to compare procedural and clinical outcomes of CRT and LBBAP.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Single-centre cohort study including consecutive patients with LVEF <45% who underwent LBBAP or CRT from Jan to Dec 2023. LBBAP was considered successful if LV activation time (LVAT) <80ms and/or V6–V1 inter-peak interval >40ms. Primary outcome was a composite of HF emergency department (ER) admission, HF hospitalization and all-cause mortality. </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">31 patients underwent LBBAP and 62 CRT. Mean age was similar across all groups (72.2 ± 10.1 years, p 0.470). 77.4% of patients were male (p 0.599). 31.2% had ischemic cardiomyopathy (p 0.739). LBBAP patients were less likely to be on beta-blockers (61.3% vs 85.5%, p 0.009), sacubitril-valsartan (54.8% vs 82.3%, p 0.005) and spironolactone (48.4% vs 72.6%, 0.022) and more likely to be on ACE inhibitor/ARBs (67.7% vs 41.9%, p 0.019). Complete left bundle branch block was present in 55.2% of patients with LBBAP (vs 66.7%, p 0.293). There were no differences regarding baseline LVEF (31±7%, p 0.425) and QRS duration (165±28ms, p 0.692).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Average LVAT was 82±8ms. Paced QRS was significantly shorter in LBBAP (118±18ms vs 152±27ms, p <0.001). LBBAP fluoroscopy (101±30min vs 116±30min, p 0.127) and procedure (18±8min vs 22±10min, p 0.161) times were shorter. Pacing thresholds were lower in LBBAP (0.6±0.3V vs 1.2±0.6V, p <0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">After a mean follow-up time of 7.3 months, LVEF increase was greater in LBBAP (14±6%) vs CRT (9±10%; p 0.147). Loss of left bundle branch capture occurred in 2 patients. In the CRT group, 5 had displacement of the coronary sinus (CS) lead and 4 had diaphragmatic stimulation. The primary outcome occurred in 10.0% of patients with LBBAP (vs 22.6%, p 0.145). After adjusting for differences at baseline, both LBBAP and CRT had similar profiles (p 0.836). </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSION</strong></span></span></p> <p><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">LBBAP led to shorter paced QRS and numerically improved LV function. Primary endpoint was similar between CRT and LBBAP patients, despite LBBAP patients having less optimized HF treatment. Our data strongly suggests LBBAP is a feasible alternative to CRT with potentially shorter procedure and fluoroscopy times.</span></span></p>
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