Denghong Zhang, Mingjian Lang, Benjamin Samraj Prakash Earnest, Ihab Elsayed Mohamed Ali Abdou
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Application and Research of Left Bundle Branch-Optimized Cardiac Resynchronization Therapy in Ischemic Cardiomyopathy.
Background: This study aimed to evaluate the effectiveness of left bundle branch-optimized cardiac resynchronization therapy (LOT-CRT) in patients diagnosed with heart failure and reduced ejection fraction due to ischemic cardiomyopathy.
Methods: A total of 78 patients with ischemic cardiomyopathy who underwent pacemaker implantation at a single center between March 2020 and March 2022 were randomly assigned to two groups based on different pacing methods: LOT-CRT group (n = 39) and biventricular pacing (BVP) group (n = 35). Pacing threshold, impedance, electrocardiogram QRS wave duration during pacing, ventricular pacing ratio during follow-up, and cardiac ultrasound-related indicators were compared immediately after surgery and at the six-month follow-up.
Results: The two groups were similar regarding baseline characteristics, cardiac ultrasound and magnetic resonance imaging (MRI) parameters, and overall cardiac function. However, the BVP group demonstrated higher pacing thresholds and impedance levels immediately after surgery and at the six-month follow-up (p < 0.001). Moreover, the X-ray exposure time was significantly longer in the BVP group compared to the LOT-CRT group. While no significant differences in QRS duration were observed between the groups preoperatively, the QRS duration in the LOT-CRT group was significantly shorter both immediately after surgery and during follow-up (p < 0.001). No significant differences were found between the groups in terms of the New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF), or left ventricular end-diastolic diameter (LVEDD). Six months post-surgery, both groups showed modest improvements in NYHA class, LVEF, and LVEDD, with the LOT-CRT group demonstrating significant improvements (p < 0.001).
Conclusions: LOT-CRT may be an alternative treatment for patients with heart failure complicated by left bundle branch block due to ischemic cardiomyopathy in whom BVP is ineffective.
期刊介绍：
RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.
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