Effect of left bundle branch area pacing on cardiac remodeling and function: propensity score matching with right ventricular pacing
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Background: Conventional right ventricular pacing (RVP) causes cardiac dyssynchrony, and increases risk of pacing-induced cardiomyopathy (PICM), heart failure hospitalization and mortality. Left bundle branch area pacing (LBBAP) is a promising physiological pacing modality, we compared the effect of LBBAP on cardiac function with RVP in patients with atrioventricular block (AVB). Methods: A total of 118 patients with AVB who successfully underwent LBBAP were enrolled between June 2019 and June 2022. Among them, 110 patients with a baseline LVEF≥50% were propensity-matched 1:1 with 49 patients who underwent RVP during the same period. Ultimately, 41 patients with well-matched baseline characteristics in both groups were included in the analysis. Echocardiographic parameters and NYHA classification at 1-year follow-up were compared between the groups. Results: Left ventricular ejection fraction (LVEF) remained stable in patients with LVEF≥50% (62.9±2.9 vs 62.9±3.3, P=0.960), and improved significantly in patients with LVEF<50% (58.0±9.9% vs 44.2±5.5%, P<0.05) at 1-year follow-up in the LBBAP group. Propensity score matching for baseline characteristics yielded 41 matched pairs. Changes in LVEF and left ventricular end-diastolic diameter (LVEDD) in the LBBAP group were significantly different from those in the RVP group: LVEF [-2.8(-5.0, -0.6), P=0.015] and LVEDD [1.3(0.1, 2.5), P=0.036], respectively. Compared with baseline, NYHA classification improved significantly in the LBBAP group (1.3 ±0.5 vs 1.0 ±0.2, P<0.05), while remained changed in the RVP group (1.3 ±0.4 vs 1.1 ±0.3, P=0.232). LBBAP showed a tendency to reduce PICM compared with RVP (0% vs 9.8%), though the difference was not significant (P=0.124). Conclusions: LBBAP might be a preferable pacing modality to improve cardiac remodeling and function in patients requiring high ventricular pacing burden compared with conventional RVP.
