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Complications of left bundle branch area pacing compared with biventricular pacing in candidates for resynchronization therapy: Results of a propensity score-matched analysis from a multicenter registry.

Complications of left bundle branch area pacing compared with biventricular pacing in candidates for resynchronization therapy: Results of a propensity score-matched analysis from a multicenter registry.

Authors :
Palmisano P
Dell'Era G
Guerra F
Ammendola E
Ziacchi M
Laffi M
Donateo P
Guido A
Ghiglieno C
Parlavecchio A
Dello Russo A
Nigro G
Biffi M
Gaggioli G
Senes J
Patti G
Accogli M
Coluccia G
Source :
Heart rhythm [Heart Rhythm] 2024 Jun; Vol. 21 (6), pp. 874-880. Date of Electronic Publication: 2024 Feb 28.
Publication Year :
2024

Abstract

Background: Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is a well-established therapy in patients with reduced left ventricular ejection fraction, heart failure, and left bundle branch block. Left bundle branch area pacing (LBBAP) has recently been shown to be a feasible and effective alternative to BVP. Comparative data on the risk of complications between LBBAP and BVP among patients undergoing CRT are lacking.<br />Objective: The aim of this study was to compare the long-term risk of procedure-related complications between LBBAP and BVP in a cohort of patients undergoing CRT.<br />Methods: This prospective, multicenter, observational study enrolled 668 consecutive patients (mean age 71.2 ± 10.0 years; 52.2% male; 59.4% with New York Heart Association class III-IV heart failure symptoms) with left ventricular ejection fraction 33.4% ± 4.3% who underwent BVP (n = 561) or LBBAP (n = 107) for a class I or II indication for CRT. Propensity score matching for baseline characteristics yielded 93 matched pairs. The rate and nature of intraprocedural and long-term post-procedural complications occurring during follow-up were prospectively collected and compared between the 2 groups.<br />Results: During a mean follow-up of 18 months, procedure-related complications were observed in 16 patients: 12 in BVP (12.9%) and 4 in LBBAP (4.3%) (P = .036). Compared with patients who underwent LBBAP, those who underwent BVP showed a lower complication-free survival (P = .032). In multivariate analysis, BVP resulted an independent predictive factor associated with a higher risk of complications (hazard ratio 3.234; P = .042). Complications related to the coronary sinus lead were most frequently observed in patients who underwent BVP (50.0% of all complications).<br />Conclusion: LBBAP was associated with a lower long-term risk of device-related complications compared with BVP in patients with an indication for CRT.<br />Competing Interests: Disclosures The authors have no conflicts to disclose.<br /> (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1556-3871
Volume :
21
Issue :
6
Database :
MEDLINE
Journal :
Heart rhythm
Publication Type :
Academic Journal
Accession number :
38428448
Full Text :
https://doi.org/10.1016/j.hrthm.2024.02.053