左束支区域起搏与双心室起搏在同步化治疗候选者中的比较。

Comparison of Left Bundle Branch Area Pacing and Biventricular Pacing in Candidates for Resynchronization Therapy.

机构信息

Geisinger Heart Institute, Wilkes Barre, Pennsylvania, USA.

Rush University Medical Center, Chicago, Illinois, USA.

出版信息

J Am Coll Cardiol. 2023 Jul 18;82(3):228-241. doi: 10.1016/j.jacc.2023.05.006. Epub 2023 May 21.

DOI:10.1016/j.jacc.2023.05.006

PMID:37220862

Abstract

BACKGROUND

Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is a well established therapy in patients with reduced left ventricular ejection fraction (LVEF), heart failure, and wide QRS or expected frequent ventricular pacing. Left bundle branch area pacing (LBBAP) has recently been shown to be a safe alternative to BVP.

OBJECTIVES

The aim of this study was to compare the clinical outcomes between BVP and LBBAP among patients undergoing CRT.

METHODS

This observational study included patients with LVEF ≤35% who underwent BVP or LBBAP for the first time for Class I or II indications for CRT from January 2018 to June 2022 at 15 international centers. The primary outcome was the composite endpoint of time to death or heart failure hospitalization (HFH). Secondary outcomes included endpoints of death, HFH, and echocardiographic changes.

RESULTS

A total of 1,778 patients met inclusion criteria: 981 BVP, 797 LBBAP. The mean age was 69 ± 12 years, 32% were female, 48% had coronary artery disease, and mean LVEF was 27% ± 6%. Paced QRS duration in LBBAP was significantly narrower than baseline (128 ± 19 ms vs 161 ± 28 ms; P < 0.001) and significantly narrower compared to BVP (144 ± 23 ms; P < 0.001). Following CRT, LVEF improved from 27% ± 6% to 41% ± 13% (P < 0.001) with LBBAP compared with an increase from 27% ± 7% to 37% ± 12% (P < 0.001) with BVP, with significantly greater change from baseline with LBBAP (13% ± 12% vs 10% ± 12%; P < 0.001). On multivariable regression analysis, the primary outcome was significantly reduced with LBBAP compared with BVP (20.8% vs 28%; HR: 1.495; 95% CI: 1.213-1.842; P < 0.001).

CONCLUSIONS

LBBAP improved clinical outcomes compared with BVP in patients with CRT indications and may be a reasonable alternative to BVP.

摘要

背景

心脏再同步治疗（CRT）联合双心室起搏（BVP）是射血分数降低（LVEF）、心力衰竭、宽 QRS 或预期频繁心室起搏的患者的一种成熟治疗方法。左束支区域起搏（LBBAP）最近已被证明是 BVP 的一种安全替代方法。

目的

本研究旨在比较 CRT 患者中 BVP 与 LBBAP 的临床结局。

方法

这项观察性研究纳入了 2018 年 1 月至 2022 年 6 月期间在 15 个国际中心因 CRT I 类或 II 类适应证首次接受 BVP 或 LBBAP 的 LVEF≤35%的患者。主要终点是死亡或心力衰竭住院（HFH）的复合终点。次要终点包括死亡、HFH 和超声心动图变化的终点。

结果

共有 1778 例患者符合纳入标准：981 例 BVP，797 例 LBBAP。平均年龄为 69±12 岁，32%为女性，48%有冠状动脉疾病，平均 LVEF 为 27%±6%。LBBAP 时的起搏 QRS 时限明显窄于基线（128±19ms 比 161±28ms；P<0.001），明显窄于 BVP（144±23ms；P<0.001）。在 CRT 后，LBBAP 组的 LVEF 从 27%±6%改善至 41%±13%（P<0.001），而 BVP 组的 LVEF 从 27%±7%改善至 37%±12%（P<0.001），LBBAP 组的改善幅度明显更大（13%±12%比 10%±12%；P<0.001）。多变量回归分析显示，与 BVP 相比，LBBAP 的主要结局显著降低（20.8%比 28%；HR：1.495；95%CI：1.213-1.842；P<0.001）。