Left bundle branch pacing vs. biventricular pacing for cardiac resynchronization therapy in the long-term: a prospective, non-randomized, cohort study.

BACKGROUND: The classical instrumental treatment for heart failure(HF) is biventricular pacing (BiV-CRT); however, BiV-CRT exhibits a non-response rate as high as 30%. This study aimed to compare the feasibility and effectiveness of cardiac resynchronization therapy(CRT) via left bundle branch pacing(LBBP-CRT) and BiV-CRT in HF patients with left bundle branch block (LBBB). METHODS AND RESULTS: This prospective, nonrandomized cohort study enrolled 140 patients who underwent CRT. Patients were divided into two groups according to pacing modality: LBBP-CRT or BiV-CRT, with a 1-year pre-planned follow-up. The success rates were 94.3% (66/70) for LBBP-CRT and 88.6% (62/70) for BiV-CRT. Compared to BiV-CRT, LBBP-CRT patients had greater pacing QRS duration(QRSd) reduction [Treatment effect (95%CI): -19.15 (-28.72, -9.59)], higher Left ventricular ejection fraction (LVEF) improvement [Treatment effect (95%CI): 2.89 (0.08, 5.71)] and better pacing parameters performance during 1-year follow-up. In a mean follow-up duration of 21.6 months, LBBP-CRT resulted in a lower risk of HF re-hospitalization [HR (95%CI): 0.250 (0.067–0.926)], while all-cause mortality was comparable between the two pacing groups. CONCLUSIONS: LBBP-CRT demonstrated better electrical synchronization, higher echocardiographic response, and lower risk of HF re-hospitalization in patients with heart failure with reduced ejection fraction(HFrEF) and LBBB. REGISTRATION NUMBER: ChiCTR2000028726, Registration date: 2020-01-01.