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Early left bundle branch pacing in heart failure with mildly reduced ejection fraction and left bundle branch block.
Zeng, Jiaxin; He, Chen; Zou, Fengwei; Qin, Chaotong; Xue, Siyuan; Zhu, Haojie; Li, Xiaofei; Liu, Zhimin; Wei, Yongyue; Hou, Shuyan; Qian, Zhiyong; Wang, Yao; Hou, Xiaofeng; Yao, Yan; Ellenbogen, Kenneth A; Fan, Xiaohan; Zou, Jiangang.
Affiliation
  • Zeng J; Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
  • He C; Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  • Zou F; Montefiore Medical Center, Bronx, New York.
  • Qin C; Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
  • Xue S; Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
  • Zhu H; Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  • Li X; Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  • Liu Z; Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  • Wei Y; Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China.
  • Hou S; Nanjing Foreign Language School, Nanjing, China.
  • Qian Z; Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
  • Wang Y; Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
  • Hou X; Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
  • Yao Y; Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  • Ellenbogen KA; Department of Cardiology, VCU School of Medicine, Richmond, Virginia.
  • Fan X; Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: fanxiaohan@fuwaihospital.org.
  • Zou J; Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China; Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China. Electroni
Heart Rhythm ; 20(10): 1436-1444, 2023 10.
Article in En | MEDLINE | ID: mdl-37495037
ABSTRACT

BACKGROUND:

Left bundle branch pacing (LBBP) achieves resynchrony and improves cardiac function in heart failure (HF) patients with reduced ejection fraction (EF) by correcting left bundle branch block (LBBB). Few data on the efficacy of early LBBP in HF with mildly reduced EF (HFmrEF) and LBBB have been reported.

OBJECTIVE:

The purpose of this study was to explore the efficacy of early LBBP in patients with HFmrEF and LBBB.

METHODS:

Consecutive patients with HFmrEF (left ventricular EF [LVEF] 35%-50%) and LBBB were prospectively enrolled to receive LBBP (Early-LBBP group) plus guideline-directed medical therapy (GDMT) or GDMT alone (GDMT group). Study outcomes included changes in LVEF, LV end-diastolic diameter (LVEDD), New York Heart Association (NYHA) functional classification, and N-terminal pro-brain natriuretic peptide (NT-proBNP), and clinical events (HF rehospitalization or syncope). Subgroup analysis compared efficacy of LBBP between patients with LBBB only without comorbidities or late gadolinium enhancement (LGE) (LBBB-Only group) and patients with either comorbidities or LGE (LBBB-Combined group).

RESULTS:

Fifty-four patients were enrolled and analyzed (37 Early-LBBP group; 15 GDMT group). LBBP achieved greater improvement in LVEF (+14.75% ± 7.37% vs -2.42% ± 2.84%; P <.001), reduction of LVEDD (-7.51 ± 5.40 mm vs -0.87 ± 4.36 mm; P <.001) and NYHA classification (-0.84 ± 0.76 vs -0.13 ± 0.74; P = .004), and similar reduction of NT-proBNP (-408.83 ± 920.29 pg/mL vs -229.05 ± 1579.17 pg/mL; P = .610) at 6 months. Early LBBP showed significantly reduced clinical events (0.0% vs 40.0%; P <.001) after 20.68 ± 13.55 months of follow-up. Subgroup analysis showed patients in the LBBB-Only group benefited more from LBBP with regard to LVEF improvement and LVEDD reduction than the LBBB-Combined group.

CONCLUSION:

Early LBBP with GDMT demonstrated greater improvement of cardiac function and reduced clinical events than GDMT alone in patients with HFmrEF and LBBB.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Ventricular Dysfunction, Left / Heart Failure Type of study: Diagnostic_studies / Etiology_studies / Guideline Limits: Humans Language: En Journal: Heart Rhythm Year: 2023 Document type: Article Affiliation country: China
Fulltext
Add to My VHL
Print
XML
PubMed Links
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Ventricular Dysfunction, Left / Heart Failure Type of study: Diagnostic_studies / Etiology_studies / Guideline Limits: Humans Language: En Journal: Heart Rhythm Year: 2023 Document type: Article Affiliation country: China