Left Bundle Branch Pacing Versus Biventricular Pacing for Acute Cardiac Resynchronization in Patients With Heart Failure

Left bundle branch pacing (LBBP) has emerged as an alternative to biventricular pacing (BVP) for delivering cardiac resynchronization therapy. We sought to compare the acute improvement of electrical and mechanical synchrony, and hemodynamics between LBBP and BVP in patients with heart failure and left bundle branch block. METHODS: LBBP and BVP were performed and compared in a crossover fashion in patients with heart failure and left bundle branch block undergoing cardiac resynchronization therapy implantation. Electrical synchrony was assessed by QRS duration and area, mechanical synchrony by the SD of time to peak velocity of 12 left ventricular segments (Ts-SD) and interventricular mechanical delay, and hemodynamics by the maximum rate of left ventricular pressure rise (dP/dt(max)). RESULTS: Twenty-one patient with heart failure and left bundle branch block (mean age 67±10 years, 48% male, and 90% nonischemic cause) were included. Both LBBP and BVP provided significant improvements in electrical and mechanical synchrony, and hemodynamics compared to the baseline. Compared with BVP, LBBP achieved a larger reduction in QRS duration (−11 ms [95% CI, −17 to −4 ms]; P=0.003) and QRS area (−85 µVs [95% CI, −113 to −56 µVs]; P<0.001); LBBP achieved a greater decrease in Ts-SD (−14 ms [95% CI, −21 to −7 ms]; P=0.001), with no significant difference in interventricular mechanical delay (−2 ms [95% CI, −13 to 8 ms]; P=0.63). The increase in dP/dt(max) from LBBP was significantly higher than that from BVP (6% [95% CI, 2%–9%]; P=0.002). CONCLUSIONS: LBBP delivers greater acute electrical and mechanical resynchronization and hemodynamic improvement than BVP in predominantly nonischemic heart failure patients with left bundle branch block. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04505384.