Li Xiaofei, Qiu Chunguang, Xie Ruiqin, Ma Wentao, Wang Zhao, Li Hui, Wang Hao, Hua Wei, Zhang Shu, Yao Yan, Fan Xiaohan
State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng, Beijing, China.
Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe E Rd, Erqi District, Zhengzhou, Henan, China.
ESC Heart Fail. 2020 Aug;7(4):1711-1722. doi: 10.1002/ehf2.12731. Epub 2020 May 13.
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).
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.
LBBAP could deliver cardiac resynchronization therapy in most patients with heart failure and LBBB, and might be a promising alternative resynchronization approach to BVP.
本多中心观察性研究旨在前瞻性评估左束支区域起搏（LBBAP）在左束支传导阻滞（LBBB）心力衰竭患者中的疗效，并比较LBBAP与双心室起搏（BVP）的6个月结局。
连续入选2018年3月至12月期间在三个不同中心接受LBBAP作为主要或挽救策略的LBBB且左心室射血分数（LVEF）≤35%的患者。通过倾向评分匹配以2:1的比例回顾性选择2018年接受BVP的患者，以尽量减少偏差。在6个月随访期间评估植入特征和超声心动图参数。LBBAP手术在81.1%（30/37）的患者中成功，其中10例为选择性LBBAP，20例中有3例联合非选择性LBBAP和左心室导线起搏以进一步缩窄QRS波。在6个月随访期间，LBBAP导致QRS波显著缩窄（从178.2±18.8毫秒降至121.8±10.8毫秒，P<0.001，27例患者起搏QRS波时限≤130毫秒）并改善LVEF（从28.8±4.5%升至44.3±8.7%，P<0.001）。对27例单纯LBBAP患者与130例匹配的BVP患者中的54例进行比较，结果显示LBBAP使QRS波时限缩窄幅度更大（58.0对12.5毫秒，P<0.001），LVEF升高幅度更大（15.6%对7.0%，P<0.001），对心脏再同步治疗的超声心动图反应（88.9%对66.7%，P=0.035）和超反应（44.4%对16.7%，P=0.007）也更大。
LBBAP可为大多数心力衰竭合并LBBB的患者提供心脏再同步治疗，可能是一种有前景的替代BVP的再同步治疗方法。
