Left bundle branch pacing cardiac resynchronization therapy vs biventricular pacing cardiac resynchronization therapy–time to write a requiem for biventricular pacing-cardiac resynchronization therapy

Abstract

Cardiac resynchronization therapy (CRT) reduces heart failure (HF) hospitalizations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch (LBB) block. Biventricular pacing (BVP) is considered the gold standard for achieving CRT; however, approximately 30%–40% of patients do not respond to BVP-CRT. Recent studies have demonstrated that LBB pacing (LBBP) produces remarkable results in CRT. In this meta-analysis, LBBP-CRT showed better outcomes than conventional BVP-CRT, including greater QRS duration reduction and left ventricular ejection fraction improvement, along with consistently lower pacing thresholds on follow-up. Additionally, there was a greater reduction in New York Heart Association class and brain natriuretic peptide levels. This study contributes to the growing body of encouraging data on LBBP-CRT from recent years. With ongoing technological advancements and increasing operator expertise, the day may not be far when LBBP-CRT becomes the standard of care rather than the exception.

Keywords: Heart failure; Left bundle branch block area pacing; Narrow QRS; New York Heart Association class; Left ventricular ejection fraction

Core Tip: Cardiac resynchronization therapy (CRT) reduces heart failure (HF) hospitalization and all-cause mortality in patients of HF with reduced ejection fraction with left bundle branch (LBB) block (LBBB). However approximately 30%–40% of patients do not respond to Biventricular pacing (BVP)-CRT. Some recent studies have shown that LBB pacing (LBBP) provides an alternative for CRT. In the current study, Yasmin et al demonstrate that LBBP-CRT is better than conventional BVP-CRT in terms of QRS duration reduction as well as left ventricular ejection fraction improvement with consistent lower pacing thresholds on follow-up. The present study adds to a body of emerging encouraging data for LBBB-CRT in the past few years. With evolving technological modification and operator experience, the day might not be far when LBBB-CRT becomes the convention rather than exception.