比较左束支起搏、左心室间隔起搏和双心室起搏用于心脏再同步治疗的长期临床结果。

Comparisons of long-term clinical outcomes with left bundle branch pacing, left ventricular septal pacing, and biventricular pacing for cardiac resynchronization therapy.

机构信息

Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.

Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.

出版信息

Heart Rhythm. 2024 Aug;21(8):1342-1353. doi: 10.1016/j.hrthm.2024.03.007. Epub 2024 Mar 9.

DOI:10.1016/j.hrthm.2024.03.007

PMID:38461922

Abstract

BACKGROUND

Left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) are referred to as left bundle branch area pacing.

OBJECTIVE

This study investigated whether long-term clinical outcomes differ in patients undergoing LBBP, LVSP, and biventricular pacing (BiVP) for cardiac resynchronization therapy (CRT).

METHODS

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 end point was all-cause mortality or heart failure hospitalization. Secondary end points included all-cause mortality, heart failure hospitalization, and echocardiographic measures of reverse remodeling.

RESULTS

A total of 259 patients (68 LBBP, 38 LVSP, and 153 BiVP) were observed for a mean duration of 28.8 ± 15.8 months. LBBP was associated with a significantly reduced risk of the primary end point by 78% compared with both BiVP (7.4% vs 41.2%; adjusted hazard ratio [aHR], 0.22 [0.08-0.57]; P = .002) and LVSP (7.4% vs 47.4%; aHR, 0.22 [0.08-0.63]; P = .004]. The adjusted risk of all-cause mortality was significantly higher in LVSP than in BiVP (31.6% vs 7.2%; aHR, 3.19 [1.38-7.39]; P = .007) but comparable between LBBP and BiVP (2.9% vs 7.2%; aHR, 0.33 [0.07-1.52], P = .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 < .001) than BiVP or LVSP.

CONCLUSION

LBBP yielded long-term clinical outcomes superior to those of BiVP and LVSP. The role of LVSP for CRT needs to be reevaluated because of its high mortality risk.

摘要

背景

左束支起搏（LBBP）和左心室间隔起搏（LVSP）被称为左束支区域起搏。

目的

本研究旨在探讨心脏再同步治疗（CRT）中接受 LBBP、LVSP 和双心室起搏（BiVP）的患者长期临床结局是否存在差异。

方法

连续纳入接受 CRT 且左心室射血分数（LVEF＜50%）降低的患者，如果成功进行 LBBP、LVSP 或 BiVP，则前瞻性纳入本研究。主要复合终点为全因死亡率或心力衰竭住院。次要终点包括全因死亡率、心力衰竭住院和超声心动图逆转重构的测量。

结果

共观察 259 例患者（68 例行 LBBP、38 例行 LVSP、153 例行 BiVP），平均随访时间为 28.8±15.8 个月。与 BiVP（7.4%比 41.2%；调整后的危险比[HR]，0.22[0.08-0.57]；P=0.002）和 LVSP（7.4%比 47.4%；调整 HR，0.22[0.08-0.63]；P=0.004）相比，LBBP 显著降低了主要终点的风险，降低了 78%。LVSP 的全因死亡率调整风险显著高于 BiVP（31.6%比 7.2%；调整 HR，3.19[1.38-7.39]；P=0.007），但与 LBBP 相当（2.9%比 7.2%；调整 HR，0.33[0.07-1.52]；P=0.155）。倾向评分调整也得到了类似的结果。与 BiVP 或 LVSP 相比，LBBP 表现出更高的超声心动图反应率（ΔLVEF≥10%：60.0%比 36.2%比 16.1%；P＜0.001）。