Complications of left bundle branch area pacing compared with biventricular pacing in candidates for resynchronization therapy: Results of a propensity score–matched analysis from a multicenter registry

Abstract

Background

Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is a well-established therapy in patients with reduced left ventricular ejection fraction (LVEF), heart failure, and left bundle branch (LBB) block. LBB area pacing (LBBAP) has recently been shown to be a feasible and effective alternative to BVP. Comparative data on the risk of complications between LBBAP and BVP among patients undergoing CRT are lacking.

Objective

The aim of this study was to compare the long-term risk of procedure-related complications between LBBAP and BVP in a cohort of patients undergoing CRT.

Methods

Prospective, multicenter, observational study enrolling 668 consecutive patients (71.2±10.0 years, 52.2% male, 59.4% NYHA class >II), with LVEF 33.4±4.3% who underwent BVP (n=561) or LBBAP (n=107) for Class I or II indications for CRT. Propensity matching for baseline characteristics yielded 93 matched pairs. Rate and nature of intra-procedural and long-term post-procedural complications occurring during follow-up were prospectively collected and compared between the two groups.

Results

During a mean follow-up of 18 months, procedure-related complications were observed in 16 patients: 12 in BVP (12.9%), and in 4 in LBBAP (4.3%) (p=0.036). Compared to LBBAP patients, BVP patients showed a lower complication-free survival (p=0.032). On multivariable analysis, BVP resulted an independent predictive factor associated with greater risk of complications (hazard ratio, 3.234, p=0.042). Complications related to coronary sinus lead were most frequently observed in BVP patients (50.0% of all complications).

Conclusions

LBBAP was associated with a lower long-term risk of device-related complications compared with BVP in patients with CRT indications.