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Povzetek: Conduction system pacing (CSP) is an emerging new method of cardiac resynchronization therapy (CRT), however, one third of patients with left bundle branch block (LBBB) have distal conduction disease, which is not amenable to correction with CSP. There is an emerging need for tailored analysis of ventricular depolarization patterns for patient selection for CRT pacing modality. We retrospectively analyzed 12 lead hrECGs, equivalent dipole (ED) trajectories and standard transthoracic echocardiograms of 18 heart failure patients fulfilling Strauss criteria for LBBB and indication for CRT randomized to the CSP arm of the ongoing CSP-Sync study (NCT05155865). Based on achievement of left bundle branch capture with shortening of left ventricular activation time, 12 patients had proximal LBBB (pLBBB group), and 6 had intact proximal LBBB conduction (dLBBB group) with similar average baseline QRS durations between the groups (179±14 ms in the pLBBB and 165±20 ms in the dLBBB group, p = 0.1). All patients fulfilled the Strauss criteria with no significant difference in the additional criterion (R wave > 0.1 mV in V1; p = 0.7). In the pLBBB group ED trajectory had an initial leftward direction (six vs. zero patients, p = 0.03) with a uniform (12 vs. one patient, p < 0.001) and slower (0.57 ± 0.12 m/s in the pLBBB vs. 0.75 ± 0.15 m/s in the dLBBB group, p = 0.01) velocity. After 6 months the pLBBB group achieved greater relative QRS duration shortening (26% ± 8% vs. 14% ± 9%; p < 0.02) and relative reductions in end left ventricle systolic volumes (41.3% ± 17.6% vs. 15.8% ± 6.1%; p = 0.004) with better improvement in ejection fraction (17.1% ± 11.0% vs. 5.5% ± 1.0%; p = 0.02). The ED trajectories from 12-lead hrECGs could better differentiate patients with proximal or distal LBBB than standard 12-lead ECG alone.
Ključne besede: 12-lead electrocardiography, body surface potential mapping, cardiac resynchronization therapy, conduction system pacing, left bundle branch block
Objavljeno v DiRROS: 06.07.2026; Ogledov: 168; Prenosov: 108
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Povzetek: Background and Aims: Left bundle branch area pacing (LBBAP) promotes physiological synchronous activation of the left ventricle and may be particularly beneficial in patients with atrioventricular block (AVB), but its mortality benefit remains unclear. This study aims to compare long-term survival in AVB patients receiving either LBBAP or right ventricular pacing (RVP) and to analyse predictors of mortality during LBBAP. Methods: MELOS RELOADED, a multicentre European collaboration, was a registry-based study of pacemaker patients with AVB, left ventricular ejection fraction (LVEF) >40% and ventricular pacing >20%. The primary outcome was all-cause mortality based on national registries. A 1:1 propensity score matching was performed between the RVP and LBBAP groups. Kaplan–Meier curves and multivariable Cox proportional hazards models were used to estimate survival. Results: In total, 3382 patients receiving LBBAP or RVP were matched. At 4-year follow-up, the Kaplan–Meier curve showed an absolute difference in survival of 11.8% in favour of LBBAP (P < .001). LBBAP was a robust predictor of reduced mortality with a hazard ratio (HR) of 0.53 (95% confidence interval 0.42–0.65, P < .001). Within the LBBAP group, the following independent predictors of increased mortality were identified: lack of confirmed left bundle branch capture (HR 1.85, P < .001), lower percentage of ventricular pacing (HR 1.12), and age. Conclusions: This is the first large study demonstrating the long-term survival benefit of LBBAP. This strengthens the use of LBBAP in AVB patients with preserved/mildly reduced LVEF while awaiting the results of randomized trials. Confirmation of left bundle branch capture seems advisable to achieve optimal results with LBBAP.
Ključne besede: conduction system pacing, left bundle branch area pacing, atrioventricular block, mortality, heart failure
Objavljeno v DiRROS: 10.04.2026; Ogledov: 1120; Prenosov: 312
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Povzetek: Aims: There are limited prospective randomized studies comparing left bundle branch area pacing (LBBAP) and biventricular (BiV) pacing for cardiac resynchronization therapy (CRT). The study tested whether LBBAP is non-inferior to BiV pacing in patients with Class I indication for CRT. Methods and results: The CSP-SYNC study is an investigator-initiated, randomized, single-centre study. Sixty-two patients were randomized 1:1 to LBBAP or BiV. The primary study endpoint was the change in left ventricular ejection fraction (LVEF) at 6 months. Secondary endpoints included changes in echo and clinical parameters after 6 months and 12 months. Thirty-one patients were randomized to each arm. Most patients were males (71%), and 32% had ischaemic cardiomyopathy. At 6 months, similar improvement of LVEF was observed in the LBBAP group compared to the BiV group [14.0% (95% confidence interval (CI): 11.2–16.8) in LBBAP vs. 8.5% (95% CI: 5.6–11.2) in BiV] with a mean intergroup difference of 5.6% (95% CI: 1.6–9.5; P < 0.001 for non-inferiority). Both groups showed comparable decrease in LVESV [−64 mL (95% CI: −78 to −50) vs. −40 mL (95% CI: −54 to −25) respectively, mean difference −24 mL (CI 95%: −44 to −4); P < 0.001 for non-inferiority] and changes in 6-min walk test (P < 0.001 for non-inferiority) and NYHA class (P = 0.011 for non-inferiority). Temporal trends of LV remodelling and heart failure hospitalization rates were also comparable. Conclusion: In patients with a Class I indication for CRT, LBBAP was non-inferior to BiV pacing in improving LVEF and provided similar structural and electrical remodelling.
Ključne besede: cardiac resynchronization therapy, biventricular pacing, left bundle branch area pacing, left bundle branch block, conduction system pacing
Objavljeno v DiRROS: 05.01.2026; Ogledov: 958; Prenosov: 512
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