Gaurav A. Upadhyay MD, FHRS , Marek Jastrzębski MD, PhD , Paul Foley MBChB, MDRes, FRCP , Badrinathan Chandrasekaran BSc, MD Res, FCRP , Zachary Whinnett MD, PhD, FHRS , Robert D. Schaller DO, FHRS , Rafał Gardas MD , Travis Richardson MD, FHRS , Pawel Moskal MD , D’Anne Kudlik MS , Robert W. Stadler PhD , Patrick Zimmerman PhD , James Burrell MS , Robert Waxman MS , Richard N. Cornelussen PhD , Jonathan Lyne MD , Bengt Herweg MD, FHRS , Pugazhendhi Vijayaraman MD, FHRS
{"title":"左束支区起搏优化心脏再同步化治疗(LOT-CRT)与传统CRT的超声心动图反应。","authors":"Gaurav A. Upadhyay MD, FHRS , Marek Jastrzębski MD, PhD , Paul Foley MBChB, MDRes, FRCP , Badrinathan Chandrasekaran BSc, MD Res, FCRP , Zachary Whinnett MD, PhD, FHRS , Robert D. Schaller DO, FHRS , Rafał Gardas MD , Travis Richardson MD, FHRS , Pawel Moskal MD , D’Anne Kudlik MS , Robert W. Stadler PhD , Patrick Zimmerman PhD , James Burrell MS , Robert Waxman MS , Richard N. Cornelussen PhD , Jonathan Lyne MD , Bengt Herweg MD, FHRS , Pugazhendhi Vijayaraman MD, FHRS","doi":"10.1016/j.hrthm.2025.04.026","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Traditional cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) may be less effective in patients with nonspecific intraventricular conduction delay (NIVCD). Left bundle branch area pacing (LBBAP) combined with left ventricular (LV) coronary venous lead pacing (LOT-CRT) may be more effective in these patients.</div></div><div><h3>Objective</h3><div>We assessed the echocardiographic response of LOT-CRT in patients with left bundle branch block (LBBB) or NIVCD and compared it with a propensity-matched BVP cohort.</div></div><div><h3>Methods</h3><div>Patients with conventional CRT indications and preferentially NIVCD were recruited. Echocardiographic parameters, including absolute percentage change in LV ejection fraction (LVEF) and relative percentage change in LV end-systolic volume (LVESV), were evaluated at implantation and 6-month follow-up. The BVP cohort was from an independent study, selected using 1:1 propensity-matching. LOT-CRT patients were subclassified into “successful LOT-CRT” (LBBAP; presence of r’ in electrode electrocardiography [ECG] V1) and “deep septal optimized therapy” (DOT-CRT) (functional deep septal capture).</div></div><div><h3>Results</h3><div>LOT-CRT patients (N = 34; age 64 years, women 38%, NIVCD 47%, LBBB 53%, implantable cardiac monitor 21%, QRSd 175 ms, and LVEF 27.6%) had significantly greater LVEF improvement (16.1% vs 6.1%; <em>P</em> <.01) and LVESV reduction (−43.5% vs −20.9%; <em>P</em> <.01) compared with BVP patients. After adjusting for baseline characteristics, LOT-CRT patients still had significantly greater LVEF improvement (7.5%; <em>P</em> <.01) and LVESV reduction (18.4%; <em>P</em> <.01) than BVP patients. The response was consistent across LBBB and NIVCD subgroups. LOT-CRT patients with QRS ≥ 171 ms showed greater benefit (<em>P</em> = .04; both LVEF and LVESV). No significant differences were observed between successful LOT-CRT and DOT-CRT.</div></div><div><h3>Conclusion</h3><div>LOT-CRT resulted in superior LVEF and LVESV improvements compared with BVP in NIVCD and LBBB patients and enhanced CRT response.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2616-2624"},"PeriodicalIF":5.7000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Echocardiographic response from left bundle branch area pacing optimized cardiac resynchronization therapy (LOT-CRT) vs traditional CRT\",\"authors\":\"Gaurav A. Upadhyay MD, FHRS , Marek Jastrzębski MD, PhD , Paul Foley MBChB, MDRes, FRCP , Badrinathan Chandrasekaran BSc, MD Res, FCRP , Zachary Whinnett MD, PhD, FHRS , Robert D. Schaller DO, FHRS , Rafał Gardas MD , Travis Richardson MD, FHRS , Pawel Moskal MD , D’Anne Kudlik MS , Robert W. Stadler PhD , Patrick Zimmerman PhD , James Burrell MS , Robert Waxman MS , Richard N. Cornelussen PhD , Jonathan Lyne MD , Bengt Herweg MD, FHRS , Pugazhendhi Vijayaraman MD, FHRS\",\"doi\":\"10.1016/j.hrthm.2025.04.026\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Traditional cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) may be less effective in patients with nonspecific intraventricular conduction delay (NIVCD). Left bundle branch area pacing (LBBAP) combined with left ventricular (LV) coronary venous lead pacing (LOT-CRT) may be more effective in these patients.</div></div><div><h3>Objective</h3><div>We assessed the echocardiographic response of LOT-CRT in patients with left bundle branch block (LBBB) or NIVCD and compared it with a propensity-matched BVP cohort.</div></div><div><h3>Methods</h3><div>Patients with conventional CRT indications and preferentially NIVCD were recruited. Echocardiographic parameters, including absolute percentage change in LV ejection fraction (LVEF) and relative percentage change in LV end-systolic volume (LVESV), were evaluated at implantation and 6-month follow-up. The BVP cohort was from an independent study, selected using 1:1 propensity-matching. LOT-CRT patients were subclassified into “successful LOT-CRT” (LBBAP; presence of r’ in electrode electrocardiography [ECG] V1) and “deep septal optimized therapy” (DOT-CRT) (functional deep septal capture).</div></div><div><h3>Results</h3><div>LOT-CRT patients (N = 34; age 64 years, women 38%, NIVCD 47%, LBBB 53%, implantable cardiac monitor 21%, QRSd 175 ms, and LVEF 27.6%) had significantly greater LVEF improvement (16.1% vs 6.1%; <em>P</em> <.01) and LVESV reduction (−43.5% vs −20.9%; <em>P</em> <.01) compared with BVP patients. After adjusting for baseline characteristics, LOT-CRT patients still had significantly greater LVEF improvement (7.5%; <em>P</em> <.01) and LVESV reduction (18.4%; <em>P</em> <.01) than BVP patients. The response was consistent across LBBB and NIVCD subgroups. LOT-CRT patients with QRS ≥ 171 ms showed greater benefit (<em>P</em> = .04; both LVEF and LVESV). No significant differences were observed between successful LOT-CRT and DOT-CRT.</div></div><div><h3>Conclusion</h3><div>LOT-CRT resulted in superior LVEF and LVESV improvements compared with BVP in NIVCD and LBBB patients and enhanced CRT response.</div></div>\",\"PeriodicalId\":12886,\"journal\":{\"name\":\"Heart rhythm\",\"volume\":\"22 10\",\"pages\":\"Pages 2616-2624\"},\"PeriodicalIF\":5.7000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart rhythm\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1547527125023458\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart rhythm","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1547527125023458","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Echocardiographic response from left bundle branch area pacing optimized cardiac resynchronization therapy (LOT-CRT) vs traditional CRT
Background
Traditional cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) may be less effective in patients with nonspecific intraventricular conduction delay (NIVCD). Left bundle branch area pacing (LBBAP) combined with left ventricular (LV) coronary venous lead pacing (LOT-CRT) may be more effective in these patients.
Objective
We assessed the echocardiographic response of LOT-CRT in patients with left bundle branch block (LBBB) or NIVCD and compared it with a propensity-matched BVP cohort.
Methods
Patients with conventional CRT indications and preferentially NIVCD were recruited. Echocardiographic parameters, including absolute percentage change in LV ejection fraction (LVEF) and relative percentage change in LV end-systolic volume (LVESV), were evaluated at implantation and 6-month follow-up. The BVP cohort was from an independent study, selected using 1:1 propensity-matching. LOT-CRT patients were subclassified into “successful LOT-CRT” (LBBAP; presence of r’ in electrode electrocardiography [ECG] V1) and “deep septal optimized therapy” (DOT-CRT) (functional deep septal capture).
Results
LOT-CRT patients (N = 34; age 64 years, women 38%, NIVCD 47%, LBBB 53%, implantable cardiac monitor 21%, QRSd 175 ms, and LVEF 27.6%) had significantly greater LVEF improvement (16.1% vs 6.1%; P <.01) and LVESV reduction (−43.5% vs −20.9%; P <.01) compared with BVP patients. After adjusting for baseline characteristics, LOT-CRT patients still had significantly greater LVEF improvement (7.5%; P <.01) and LVESV reduction (18.4%; P <.01) than BVP patients. The response was consistent across LBBB and NIVCD subgroups. LOT-CRT patients with QRS ≥ 171 ms showed greater benefit (P = .04; both LVEF and LVESV). No significant differences were observed between successful LOT-CRT and DOT-CRT.
Conclusion
LOT-CRT resulted in superior LVEF and LVESV improvements compared with BVP in NIVCD and LBBB patients and enhanced CRT response.
期刊介绍:
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.