Palmisano Pietro, Dell'Era Gabriele, Guerra Federico, Ammendola Ernesto, Ziacchi Matteo, Laffi Mattia, Donateo Paolo, Guido Alessandro, Ghiglieno Chiara, Parlavecchio Antonio, Dello Russo Antonio, Nigro Gerardo, Biffi Mauro, Gaggioli Germano, Senes Jacopo, Patti Giuseppe, Accogli Michele, Coluccia Giovanni
Cardiology Unit, "Card. G. Panico" Hospital, Tricase, Italy.
Division of Cardiology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
Heart Rhythm. 2024 Jun;21(6):874-880. doi: 10.1016/j.hrthm.2024.02.053. Epub 2024 Feb 28.
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.
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.
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.
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).
LBBAP was associated with a lower long-term risk of device-related complications compared with BVP in patients with an indication for CRT.
双心室起搏（BVP）的心脏再同步治疗（CRT）是左心室射血分数降低、心力衰竭和左束支传导阻滞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的一种可行且有效的替代方法。CRT患者中LBBAP和BVP之间并发症风险的比较数据尚缺乏。
本研究的目的是比较CRT患者队列中LBBAP和BVP与手术相关并发症的长期风险。
这项前瞻性、多中心、观察性研究纳入了668例连续患者（平均年龄71.2±10.0岁；52.2%为男性；59.4%有纽约心脏协会III-IV级心力衰竭症状），左心室射血分数为33.4%±4.3%，因I类或II类CRT适应证接受BVP（n = 561）或LBBAP（n = 107）。对基线特征进行倾向评分匹配产生了93对匹配对。前瞻性收集并比较两组在随访期间发生的术中及术后长期并发症的发生率和性质。
在平均18个月的随访期间，16例患者出现了与手术相关的并发症：BVP组12例（12.9%），LBBAP组4例（4.3%）（P = 0.036）。与接受LBBAP的患者相比，接受BVP的患者无并发症生存率较低（P = 0.032）。在多变量分析中，BVP是与较高并发症风险相关的独立预测因素（风险比3.234；P = 0.042）。与冠状窦导联相关并发症在接受BVP的患者中最常见（占所有并发症的50.0%）。
在有CRT适应证的患者中，与BVP相比，LBBAP与较低的与器械相关并发症的长期风险相关。
