Cardiac resynchronization therapy via left bundle branch pacing in heart failure with complete left bundle branch block: is the defibrillator needed?
AimsThis retrospective cohort study aimed to investigate the efficacy of dual-chamber left Bundle branch pacing (LBBP) as an alternative therapy for heart failure patients with complete left bundle branch block (CLBBB) and indications for defibrillator with cardiac resynchronization therapy (CRT-D)....
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1518349/full |
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| author | Dandan Yang Dandan Yang Qunchao Ma Qunchao Ma Hong Zhu Lihua Wang Meixiang Xiang Meixiang Xiang Jian’an Wang Jian’an Wang Jian’an Wang Jian’an Wang Xiaohong Pan Xiaohong Pan |
| author_facet | Dandan Yang Dandan Yang Qunchao Ma Qunchao Ma Hong Zhu Lihua Wang Meixiang Xiang Meixiang Xiang Jian’an Wang Jian’an Wang Jian’an Wang Jian’an Wang Xiaohong Pan Xiaohong Pan |
| author_sort | Dandan Yang |
| collection | DOAJ |
| description | AimsThis retrospective cohort study aimed to investigate the efficacy of dual-chamber left Bundle branch pacing (LBBP) as an alternative therapy for heart failure patients with complete left bundle branch block (CLBBB) and indications for defibrillator with cardiac resynchronization therapy (CRT-D).Methods34 patients met inclusion criteria were enrolled in the study. These criteria included a left ventricular ejection fraction (LVEF) of lower than 35%, a New York Heart Association functional class of II–IV, CLBBB meeting Strauss's criteria, intraventricular dyssynchrony, and confirmed correction of CLBBB during LBBP. Patients with ischemic cardiomyopathy, left ventricular noncompaction, significant late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR), and indications for an implantable cardioverter-defibrillator (ICD) as secondary prevention were excluded.ResultsPost-LBBP, the LVEF improved from 31.1 ± 4.0% to 61.0 ± 6.0% (P < 0.001). All patients exhibited a super-response to LBBP cardiac resynchronization therapy, achieving complete improvement in cardiac function with a LVEF exceeding 50%. Septal-to-posterior wall motion delay (SPWMD) and systolic dyssynchrony index (SDI) were indicators of intraventricular synchrony, SPWMD decreased from 271.4 ± 76.4 ms to 42.2 ± 22.9 ms (P < 0.001), and SDI decreased from 12.5 ± 5.3% to 1.9 ± 1.0% after implantation (P < 0.001).ConclusionsHeart failure patients meeting the following criteria may be considered for dual-chamber pacing as an alternative to CRT-D, potentially avoiding the need for ICD implantation: (1) CLBBB meeting Strauss's criteria, (2) presence of intraventricular dyssynchrony on echocardiogram, (3) exclusion of secondary prevention ICD indications, (4) absence of evident LGE on CMR, and (5) successful correction of CLBBB during LBBP. |
| format | Article |
| id | doaj-art-48d9ccf31c0d4170ac6081f283ea68ab |
| institution | Kabale University |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-48d9ccf31c0d4170ac6081f283ea68ab2025-01-14T06:10:44ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-01-011210.3389/fcvm.2025.15183491518349Cardiac resynchronization therapy via left bundle branch pacing in heart failure with complete left bundle branch block: is the defibrillator needed?Dandan Yang0Dandan Yang1Qunchao Ma2Qunchao Ma3Hong Zhu4Lihua Wang5Meixiang Xiang6Meixiang Xiang7Jian’an Wang8Jian’an Wang9Jian’an Wang10Jian’an Wang11Xiaohong Pan12Xiaohong Pan13Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaState Key Laboratory of Transvascular Implantation Devices, Hangzhou, ChinaDepartment of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaState Key Laboratory of Transvascular Implantation Devices, Hangzhou, ChinaDepartment of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaDepartment of Radiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaDepartment of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaState Key Laboratory of Transvascular Implantation Devices, Hangzhou, ChinaDepartment of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaState Key Laboratory of Transvascular Implantation Devices, Hangzhou, ChinaHeart Regeneration and Repair Key Laboratory of Zhejiang province, Hangzhou, ChinaResearch Center for Life Science and Human Health, Binjiang Institute of Zhejiang University, Hangzhou, ChinaDepartment of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaState Key Laboratory of Transvascular Implantation Devices, Hangzhou, ChinaAimsThis retrospective cohort study aimed to investigate the efficacy of dual-chamber left Bundle branch pacing (LBBP) as an alternative therapy for heart failure patients with complete left bundle branch block (CLBBB) and indications for defibrillator with cardiac resynchronization therapy (CRT-D).Methods34 patients met inclusion criteria were enrolled in the study. These criteria included a left ventricular ejection fraction (LVEF) of lower than 35%, a New York Heart Association functional class of II–IV, CLBBB meeting Strauss's criteria, intraventricular dyssynchrony, and confirmed correction of CLBBB during LBBP. Patients with ischemic cardiomyopathy, left ventricular noncompaction, significant late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR), and indications for an implantable cardioverter-defibrillator (ICD) as secondary prevention were excluded.ResultsPost-LBBP, the LVEF improved from 31.1 ± 4.0% to 61.0 ± 6.0% (P < 0.001). All patients exhibited a super-response to LBBP cardiac resynchronization therapy, achieving complete improvement in cardiac function with a LVEF exceeding 50%. Septal-to-posterior wall motion delay (SPWMD) and systolic dyssynchrony index (SDI) were indicators of intraventricular synchrony, SPWMD decreased from 271.4 ± 76.4 ms to 42.2 ± 22.9 ms (P < 0.001), and SDI decreased from 12.5 ± 5.3% to 1.9 ± 1.0% after implantation (P < 0.001).ConclusionsHeart failure patients meeting the following criteria may be considered for dual-chamber pacing as an alternative to CRT-D, potentially avoiding the need for ICD implantation: (1) CLBBB meeting Strauss's criteria, (2) presence of intraventricular dyssynchrony on echocardiogram, (3) exclusion of secondary prevention ICD indications, (4) absence of evident LGE on CMR, and (5) successful correction of CLBBB during LBBP.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1518349/fullleft bundle branch pacingcardiac resynchronization therapyleft bundle branch blockheart failureimplantable cardioverter defibrillator |
| spellingShingle | Dandan Yang Dandan Yang Qunchao Ma Qunchao Ma Hong Zhu Lihua Wang Meixiang Xiang Meixiang Xiang Jian’an Wang Jian’an Wang Jian’an Wang Jian’an Wang Xiaohong Pan Xiaohong Pan Cardiac resynchronization therapy via left bundle branch pacing in heart failure with complete left bundle branch block: is the defibrillator needed? Frontiers in Cardiovascular Medicine left bundle branch pacing cardiac resynchronization therapy left bundle branch block heart failure implantable cardioverter defibrillator |
| title | Cardiac resynchronization therapy via left bundle branch pacing in heart failure with complete left bundle branch block: is the defibrillator needed? |
| title_full | Cardiac resynchronization therapy via left bundle branch pacing in heart failure with complete left bundle branch block: is the defibrillator needed? |
| title_fullStr | Cardiac resynchronization therapy via left bundle branch pacing in heart failure with complete left bundle branch block: is the defibrillator needed? |
| title_full_unstemmed | Cardiac resynchronization therapy via left bundle branch pacing in heart failure with complete left bundle branch block: is the defibrillator needed? |
| title_short | Cardiac resynchronization therapy via left bundle branch pacing in heart failure with complete left bundle branch block: is the defibrillator needed? |
| title_sort | cardiac resynchronization therapy via left bundle branch pacing in heart failure with complete left bundle branch block is the defibrillator needed |
| topic | left bundle branch pacing cardiac resynchronization therapy left bundle branch block heart failure implantable cardioverter defibrillator |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1518349/full |
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