Should cardiac conduction system pacing replace bi-ventricular pacing for patients with refractory heart failure (HF)? The two forms of conduction system pacing are His bundle pacing and left bundle branch area pacing.
Vijayaraman et al(1)have published the results of a retrospective multi center study to asses the feasibility and outcomes of left bundle branch area pacing (LBBAP) in patients as an alternative to bi-ventricular pacing (Bi-V). See herehttps://www.jacc.org/doi/pdf/10.1016/j.jacep.2020.08.015
LBBAP pacing was attempted in 325 patients and was successful in 277 or 85%.LBBAP resulted in significant shortening of the QRS,clinical and echocardiographic improvement, and was achieved with low thresholds and adequately high R waves. In short, LBBAP seemed feasible and safe. No mention was made in the abstract regarding septal wall perforation an event that had been reported in some earlier case series.
Among clinical indications for pacemaker implantation none equal the randomized clinic trial data supporting CRT using BIV.
There are observational data supporting the value of both His Bundle pacing and now LBBAP as an alternative to Bi V pacing. I think a large RCT would be necessary to demonstrate superiority or more likely non-inferiority of cardiac conduction pacing versus BiV.Where would funding for that be found?
1)Vijayaraman,p et al Left bundle branch area pacing for cardiac resynchronization therapy:Results from the International LBBAP collaborative study. JACC Clin EP archives, vol 7 no. 2 135-137.
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