Aims This multicentre observational study aimed to prospectively assess the efficacy of left bundle branch area pacing (LBBAP) in heart failure patients with left bundle branch block (LBBB) and compare the 6‐month outcomes between LBBAP and biventricular pacing (BVP). Methods and results Consecutive patients with LBBB and left ventricular ejection fraction (LVEF) ≤ 35% were prospectively recruited if they had undergone LBBAP as a primary or rescue strategy from three separate centres from March to December 2018. Patients who received BVP in 2018 were retrospectively selected by using 2 to 1 propensity score matching to minimize bias. Implant characteristics and echocardiographic parameters were assessed during the 6‐month follow‐up. LBBAP procedure succeeded in 81.1% (30/37) of patients, with selective LBBAP in 10 patients, and 3 of 20 patients combined non‐selective LBBAP and LV lead pacing for further QRS narrowing. LBBAP resulted in significant QRS narrowing (from 178.2 ± 18.8 to 121.8 ± 10.8 ms, P < 0.001, paced QRS duration ≤ 130 ms in 27 patients) and improved LVEF (from 28.8 ± 4.5% to 44.3 ± 8.7%, P < 0.001) during the 6‐month follow‐up. The comparison between 27 patients with LBBAP alone and 54 of 130 matching patients with BVP showed that LBBAP delivered a greater reduction in the QRSd (58.0 vs. 12.5 ms, P < 0.001), a greater increase in LVEF (15.6% vs. 7.0%, P < 0.001), and greater echocardiographic (88.9% vs. 66.7%, P = 0.035) and super response (44.4% vs. 16.7%, P = 0.007) to cardiac resynchronization therapy. Conclusions LBBAP could deliver cardiac resynchronization therapy in most patients with heart failure and LBBB, and might be a promising alternative resynchronization approach to BVP.

Left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) are referred to as left bundle branch area pacing (LBBAP). This study investigated whether long-term clinical outcomes differ in patients undergoing LBBP, LVSP, and biventricular pacing (BiVP) for cardiac resynchronization therapy (CRT). Consecutive patients with reduced left ventricular ejection fraction (LVEF<50%) undergoing CRT were prospectively enrolled if they underwent successful LBBP, LVSP, or BiVP. The primary composite endpoint was all-cause mortality or heart failure hospitalization (HFH). Secondary endpoints included all-cause mortality, HFH, and echocardiographic measures of reverse remodeling. A total of 259 patients (68 LBBP, 38 LVSP, and 153 BiVP) were followed for a mean duration of 28.8 ± 15.8 months. LBBP was associated with a significantly reduced risk of the primary endpoint by 78% compared to both BiVP [7.4% vs. 41.2%; adjusted hazard ratio (aHR) 0.22 (0.08, 0.57), p=0.002] and LVSP [7.4% vs. 47.4%; aHR 0.22 (0.08, 0.63), p=0.004]. The adjusted risk of all-cause mortality was significantly higher in LVSP than BiVP [31.6% vs. 7.2%, aHR 3.19 (1.38, 7.39); p=0.007] but comparable between LBBP and BiVP [2.9% vs. 7.2%, aHR 0.33 (0.07, 1.52), p=0.155]. Propensity score adjustment also obtained similar results. LBBP showed a higher rate of echocardiographic response (ΔLVEF ≥10%: 60.0% vs. 36.2% vs. 16.1%; p<0.001) than BiVP or LVSP. LBBP yielded superior long-term clinical outcomes to BiVP and LVSP. The role of LVSP for CRT needs to be reevaluated due to its high mortality risk.

Due to global population aging, atrial fibrillation/flutter (AF/AFL) has become the most prevalent persistent type of arrhythmia worldwide and a leading cause of systemic embolism, particularly ischemic stroke, heart failure, and other cardiovascular illness [1,2], resulting in direct and indirect family and societal costs. The Global Burden of Diseases (GBD) study 2017 reported on the […]