Outcomes of Upgrading to LBBP in CRT Nonresponders

doi:10.1016/j.jacep.2023.08.031

科研成果详情

题名	Outcomes of Upgrading to LBBP in CRT Nonresponders
作者	Chen, Xueying 1; Jin, Qinchun 1; Qiu, Zhaohui 2; Qian, Caizhen 3; Liang, Yixiu 1; Wang, Jingfeng 1; Qin, Shengmei 1; Bai, Jin 1; Wang, Wei 1; Chen, Haiyan 4; Dong, Yingxue 5; Huang, Weijian6; Su, Yangang 1
发表日期	2024-01
发表期刊	JACC-CLINICAL ELECTROPHYSIOLOGY 影响因子和分区
语种	英语
原始文献类型	Article
关键词	biventricular pacing cardiac resynchronization therapy left bundle branch pacing response
其他关键词	CARDIAC-RESYNCHRONIZATION THERAPY ; DEFIBRILLATOR IMPLANTATION TRIAL ; HEART-FAILURE PATIENTS ; PREDICTORS
摘要	Background: Cardiac resynchronization therapy (CRT) nonresponders account for nearly 30% of CRT candidates. Left-bundle branch pacing (LBBP) is an alternative to CRT. Objectives: This study aimed to evaluate the feasibility, clinical efficacy, and outcomes of upgrading to LBBP in CRT nonresponders, using propensity-score matching (PSM) analysis. Methods: CRT nonresponders were defined as those with an implantable CRT-pacemaker or CRT-defibrillator for more than 12 months who remained nonresponsive (a decrease in left ventricular end-systolic volume of <15% or a left ventricular ejection fraction [LVEF] absolute increase of <5%) after optimal medical therapy and device optimization compared with baseline. In total, 145 CRT nonresponders were prospectively enrolled and randomly divided into 2 groups: upgraded to LBBP (n = 48), and continuing biventricular pacing (BVP) (control; n = 97). PSM was performed at a 1:1 ratio, and clinical evaluation and echocardiographic assessments were compared at baseline and follow-up in paired cohorts. The primary composite endpoint for clinical outcomes (heart failure-related rehospitalization events, all-cause death, or heart transplantation) was analyzed. Results: Successful upgrading to LBBP was achieved in 48/49 patients (97.96%), with a significant decrease in QRS duration (P < 0.001). In the paired LBBP group, LVEF significantly increased (baseline: 29.75% +/- 7.79%; 6 months: 37.78% +/- 9.25% [P < 0.001]; 12 months: 38.84% +/- 12.13% [P < 0.001]) with 21/44 patients (47.73%) classified as echocardiographically responsive, whereas in the BVP control group, no significant improvement was observed (29.55% +/- 6.74% vs 29.22% +/- 8.10%; P = 0.840). In a multivariate logistic regression model, LV end-diastolic volume and baseline LBBB QRS morphology were independent predictors of echocardiographic response after upgrading to LBBP. At a median 24 months, the primary composite endpoint was significantly lower in the LBBP group (HR: 0.31; 95% CI: 0.14-0.72; log-rank P = 0.007). Conclusions: Upgrading to LBBP is feasible and effective in achieving significant heart function improvement and better clinical outcomes in CRT nonresponders, making it a reasonable and promising pacing strategy. (LBBP in CRT Non-Response patients; ChiCTR1900028131).
资助项目	National Natural Science Found [82170387]; Clinical Research Special Fund of Zhongshan Hospital, Fudan University [2020ZSLC08]
出版者	ELSEVIER
ISSN	2405-500X
EISSN	2405-5018
卷号	10 期号:1 页码:108-120
DOI	10.1016/j.jacep.2023.08.031
页数	13
WOS类目	Cardiac & Cardiovascular Systems
WOS研究方向	Cardiovascular System & Cardiology
WOS记录号	WOS:001177822000001
收录类别	SCIE ; PUBMED ; SCOPUS
在线发表日期	2024-01
URL	查看原文
PubMed ID	37943191
SCOPUSEID	2-s2.0-85178247854
通讯作者地址	[Dong, Yingxue]Department of Cardiology,222 Zhongshan Road, First Affiliated Hospital of Dalian Medical University,Dalian,116014,China ; [Huang, Weijian]Department of Cardiology,The First Affiliated Hospital of Wenzhou Medical University,Wenzhou,325015,China ; [Su, Yangang]Department of Cardiology,Zhongshan Hospital,Fudan University,180 Fenglin Road,Shanghai,200032,China
Scopus学科分类	Cardiology and Cardiovascular Medicine;Physiology (medical)
TOP期刊	TOP期刊
引用统计
文献类型	期刊论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/209428
专题	其他_附属诸暨医院（诸暨市人民医院）第一临床医学院（信息与工程学院）、附属第一医院附属第一医院
通讯作者	Dong, Yingxue; Huang, Weijian; Su, Yangang
作者单位	1.Department of Cardiology,Zhongshan Hospital of Fudan University,Shanghai Institute of Cardiovascular Diseases,National Clinical Research Center for Interventional Medicine,Shanghai,China; 2.Division of Cardiology,TongRen Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,China; 3.Zhuji People's Hospital Affiliated of Wenzhou Medical University,Wenzhou,China; 4.Department of Cardiac Echocardiology,Zhongshan Hospital,Fudan University,Shanghai,China; 5.Department of Cardiology,First Affiliated Hospital of Dalian Medical University,Dalian,China; 6.Department of Cardiology,The First Affiliated Hospital of Wenzhou Medical University,Wenzhou,China
通讯作者单位	附属第一医院; 第一临床医学院（信息与工程学院）、附属第一医院
推荐引用方式 GB/T 7714	Chen, Xueying,Jin, Qinchun,Qiu, Zhaohui,et al. Outcomes of Upgrading to LBBP in CRT Nonresponders[J]. JACC-CLINICAL ELECTROPHYSIOLOGY,2024,10(1):108-120.
APA	Chen, Xueying., Jin, Qinchun., Qiu, Zhaohui., Qian, Caizhen., Liang, Yixiu., ... & Su, Yangang. (2024). Outcomes of Upgrading to LBBP in CRT Nonresponders. JACC-CLINICAL ELECTROPHYSIOLOGY, 10(1), 108-120.
MLA	Chen, Xueying,et al."Outcomes of Upgrading to LBBP in CRT Nonresponders".JACC-CLINICAL ELECTROPHYSIOLOGY 10.1(2024):108-120.