Advertisement

Clinical outcomes of left bundle branch area pacing compared to right ventricular pacing: Results from the Geisinger-Rush Conduction System Pacing Registry

Published:September 02, 2021DOI:https://doi.org/10.1016/j.hrthm.2021.08.033

      Background

      Left bundle branch area pacing (LBBAP) has been shown to be a feasible option for patients requiring ventricular pacing.

      Objective

      The purpose of this study was to compare clinical outcomes between LBBAP and RVP among patients undergoing pacemaker implantation

      Methods

      This observational registry included patients who underwent pacemaker implantations with LBBAP or RVP for bradycardia indications between April 2018 and October 2020. The primary composite outcome included all-cause mortality, heart failure hospitalization (HFH), or upgrade to biventricular pacing. Secondary outcomes included the composite endpoint among patients with a prespecified burden of ventricular pacing and individual outcomes.

      Results

      A total of 703 patients met inclusion criteria (321 LBBAP and 382 RVP). QRS duration during LBBAP was similar to baseline (121 ± 23 ms vs 117 ± 30 ms; P = .302) and was narrower compared to RVP (121 ± 23 ms vs 156 ± 27 ms; P <.001). The primary composite outcome was significantly lower with LBBAP (10.0%) compared to RVP (23.3%) (hazard ratio [HR] 0.46; 95%T confidence interval [CI] 0.306–0.695; P <.001). Among patients with ventricular pacing burden >20%, LBBAP was associated with significant reduction in the primary outcome compared to RVP (8.4% vs 26.1%; HR 0.32; 95% CI 0.187–0.540; P <.001). LBBAP was also associated with significant reduction in mortality (7.8% vs 15%; HR 0.59; P = .03) and HFH (3.7% vs 10.5%; HR 0.38; P = .004).

      Conclusion

      LBBAP resulted in improved clinical outcomes compared to RVP. Higher burden of ventricular pacing (>20%) was the primary driver of these outcome differences.

      Graphical abstract

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lamas G.A.
        • Lee K.L.
        • Sweeney M.O.
        • et al.
        Ventricular pacing or dual-chamber pacing for sinus-node dysfunction.
        N Engl J Med. 2002; 346: 1854-1862
        • Sweeney M.O.
        • Hellkamp A.S.
        • Ellenbogen K.A.
        • et al.
        Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction.
        Circulation. 2003; 107: 2932-2937
        • Toff W.D.
        • Camm A.J.
        • Skehan J.D.
        Single-chamber versus dual-chamber pacing for high-grade atrioventricular block.
        N Engl J Med. 2005; 353: 145-155
        • Khurshid S.
        • Epstein A.E.
        • Verdino R.J.
        • et al.
        Incidence and predictors of right ventricular pacing-induced cardiomyopathy.
        Heart Rhythm. 2014; 11: 1619-1625
        • Kiehl E.L.
        • Makki T.
        • Kumar R.
        • et al.
        Incidence and predictors of right ventricular pacing-induced cardiomyopathy in patients with complete atrioventricular block and preserved left ventricular systolic function.
        Heart Rhythm. 2016; 13: 2272-2278
        • Sharma P.S.
        • Dandamudi G.
        • Naperkowski A.
        • et al.
        Permanent His-bundle pacing is feasible, safe, and superior to right ventricular pacing in routine clinical practice.
        Heart Rhythm. 2015; 12: 305-312
        • Vijayaraman P.
        • Naperkowski A.
        • Subzposh F.A.
        • et al.
        Permanent His-bundle pacing: long-term lead performance and clinical outcomes.
        Heart Rhythm. 2018; 15: 696-702
        • Abdelrahman M.
        • Subzposh F.A.
        • Beer D.
        • et al.
        Clinical outcomes of His bundle pacing compared to right ventricular pacing.
        J Am Coll Cardiol. 2018; 71: 2319-2330
        • Ravi V.
        • Beer D.
        • Pietrasik G.M.
        • et al.
        Development of new-onset or progressive atrial fibrillation in patients with permanent His bundle pacing versus right ventricular pacing: results from the RUSH HBP Registry.
        J Am Heart Assoc. 2020; 9e018478
        • Barba-Pichardo R.
        • Morina-Vazquez P.
        • Venegas-Gamero J.
        • Maroto-Monserrat F.
        • Cid-Cumplido M.
        • Herrera-Carranza M.
        [Permanent His-bundle pacing in patients with infra-Hisian atrioventricular block].
        Rev Esp Cardiol. 2006; 59: 553-558
        • Bhatt A.G.
        • Musat D.L.
        • Milstein N.
        • et al.
        The efficacy of His bundle pacing: lessons learned from implementation for the first time at an experienced electrophysiology center.
        JACC Clin Electrophysiol. 2018; 4: 1397-1406
        • Teigeler T.
        • Kolominsky J.
        • Vo C.
        • et al.
        Intermediate-term performance and safety of His-bundle pacing leads: a single-center experience.
        Heart Rhythm. 2021; 18: 743-749
        • Huang W.
        • Su L.
        • Wu S.
        • et al.
        A novel pacing strategy with low and stable output: pacing the left bundle branch immediately beyond the conduction block.
        Can J Cardiol. 2017; 33 (1736.e1731-1736.e1733)
        • Vijayaraman P.
        • Subzposh F.A.
        • Naperkowski A.
        • et al.
        Prospective evaluation of feasibility and electrophysiologic and echocardiographic characteristics of left bundle branch area pacing.
        Heart Rhythm. 2019; 16: 1774-1782
        • Su L.
        • Wang S.
        • Wu S.
        • et al.
        Long-term safety and feasibility of left bundle branch pacing in a large single-center study.
        Circ Arrhythm Electrophysiol. 2021; 14e009261
        • Padala S.K.
        • Master V.M.
        • Terricabras M.
        • et al.
        Initial experience, safety, and feasibility of left bundle branch area pacing: a multicenter prospective study.
        JACC Clin Electrophysiol. 2020; 6: 1773-1782
        • Tracy C.M.
        • Epstein A.E.
        • Darbar D.
        • et al.
        2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2012; 60: 1297-1313
        • Huang W.
        • Chen X.
        • Su L.
        • Wu S.
        • Xia X.
        • Vijayaraman P.
        A beginner's guide to permanent left bundle branch pacing.
        Heart Rhythm. 2019; 16: 1791-1796
        • Lustgarten D.L.
        • Sharma P.S.
        • Vijayaraman P.
        Troubleshooting and programming considerations for His bundle pacing.
        Heart Rhythm. 2019; 16: 654-662