D’après la présentation de Pugazhendhi Vijayaraman : “Left Bundle Branch Area Pacing compared to Biventricular Pacing in candidate for Cardiac Resynchronization Therapy”.
Key messages
Superiority over the mortality or hospitalization criterion for heart failure to stimulate the left branch vs resynchronization conventional in an international multicenter register.
Introduction
Stimulation of the left branch makes it possible to refine the QRS and could present an alternative to conventional resynchronization. Low number of randomized registers and randomized studies suggest this. The 2 techniques were compared on the I-Clas International Multicenter Register.
Methodology and results
Methods
The I-Clas International Multicenter Register included from June 2018 to June 2023 with minimum monitoring 6 months, 2579 patients: 68% men, average age 70 years, FE <50% (average 32%, 34% LBBP group, 29% CRT group), ischemic cardiopathy 33% and non-ischemic 68%, relating to a resynchronization (QRS Middle 156 ms). 68% DAI location and 32% PM. A propensity score has been applied to optimize the comparison between the 2 groups.
Judgment criterion: The primary criterion combined mortality or hospitalization for heart failure.
Results
22.2% in stimulation of left branch vs 30.8% in biventricular stimulation.
The rhythmic events FA, TV, FV were significantly reduced in the LBBP group.
Discussion
The BVP group had fewer women, less cmd, lower, fewer patients with FE 41-50% (7% vs 35%).
Conclusion
This study is an additional argument in favor of the possible superiority of the stimulation of the left branch over conventional resynchronization.
The limits are the retrospective design, not intention to treat and produced in experienced centers. These data must be confirmed by large randomized studies.
Figure 1
References
Vijayaraman P, Sharma PS, Cano Ó, et al. Comparison of Left Bundle Branch Area Pacing and Biventricular Pacing in Candidates for Resynchronization Therapy. J Am Coll Cardiol. 2023;82(3):228-241. doi:10.1016/j.jacc.2023.05.006
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