PMID- 37495037 OWN - NLM STAT- MEDLINE DCOM- 20231002 LR - 20231002 IS - 1556-3871 (Electronic) IS - 1547-5271 (Linking) VI - 20 IP - 10 DP - 2023 Oct TI - Early left bundle branch pacing in heart failure with mildly reduced ejection fraction and left bundle branch block. PG - 1436-1444 LID - S1547-5271(23)02545-6 [pii] LID - 10.1016/j.hrthm.2023.07.063 [doi] AB - BACKGROUND: Left bundle branch pacing (LBBP) achieves resynchrony and improves cardiac function in heart failure (HF) patients with reduced ejection fraction (EF) by correcting left bundle branch block (LBBB). Few data on the efficacy of early LBBP in HF with mildly reduced EF (HFmrEF) and LBBB have been reported. OBJECTIVE: The purpose of this study was to explore the efficacy of early LBBP in patients with HFmrEF and LBBB. METHODS: Consecutive patients with HFmrEF (left ventricular EF [LVEF] 35%-50%) and LBBB were prospectively enrolled to receive LBBP (Early-LBBP group) plus guideline-directed medical therapy (GDMT) or GDMT alone (GDMT group). Study outcomes included changes in LVEF, LV end-diastolic diameter (LVEDD), New York Heart Association (NYHA) functional classification, and N-terminal pro-brain natriuretic peptide (NT-proBNP), and clinical events (HF rehospitalization or syncope). Subgroup analysis compared efficacy of LBBP between patients with LBBB only without comorbidities or late gadolinium enhancement (LGE) (LBBB-Only group) and patients with either comorbidities or LGE (LBBB-Combined group). RESULTS: Fifty-four patients were enrolled and analyzed (37 Early-LBBP group; 15 GDMT group). LBBP achieved greater improvement in LVEF (+14.75% +/- 7.37% vs -2.42% +/- 2.84%; P <.001), reduction of LVEDD (-7.51 +/- 5.40 mm vs -0.87 +/- 4.36 mm; P <.001) and NYHA classification (-0.84 +/- 0.76 vs -0.13 +/- 0.74; P = .004), and similar reduction of NT-proBNP (-408.83 +/- 920.29 pg/mL vs -229.05 +/- 1579.17 pg/mL; P = .610) at 6 months. Early LBBP showed significantly reduced clinical events (0.0% vs 40.0%; P <.001) after 20.68 +/- 13.55 months of follow-up. Subgroup analysis showed patients in the LBBB-Only group benefited more from LBBP with regard to LVEF improvement and LVEDD reduction than the LBBB-Combined group. CONCLUSION: Early LBBP with GDMT demonstrated greater improvement of cardiac function and reduced clinical events than GDMT alone in patients with HFmrEF and LBBB. CI - Copyright (c) 2023 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved. FAU - Zeng, Jiaxin AU - Zeng J AD - Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China. FAU - He, Chen AU - He C AD - Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. FAU - Zou, Fengwei AU - Zou F AD - Montefiore Medical Center, Bronx, New York. FAU - Qin, Chaotong AU - Qin C AD - Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China. FAU - Xue, Siyuan AU - Xue S AD - Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China. FAU - Zhu, Haojie AU - Zhu H AD - Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. FAU - Li, Xiaofei AU - Li X AD - Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. FAU - Liu, Zhimin AU - Liu Z AD - Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. FAU - Wei, Yongyue AU - Wei Y AD - Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China. FAU - Hou, Shuyan AU - Hou S AD - Nanjing Foreign Language School, Nanjing, China. FAU - Qian, Zhiyong AU - Qian Z AD - Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China. FAU - Wang, Yao AU - Wang Y AD - Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China. FAU - Hou, Xiaofeng AU - Hou X AD - Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China. FAU - Yao, Yan AU - Yao Y AD - Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. FAU - Ellenbogen, Kenneth A AU - Ellenbogen KA AD - Department of Cardiology, VCU School of Medicine, Richmond, Virginia. FAU - Fan, Xiaohan AU - Fan X AD - Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: fanxiaohan@fuwaihospital.org. FAU - Zou, Jiangang AU - Zou J AD - Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China; Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China. Electronic address: jgzou@njmu.edu.cn. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230724 PL - United States TA - Heart Rhythm JT - Heart rhythm JID - 101200317 RN - 0 (Contrast Media) RN - AU0V1LM3JT (Gadolinium) SB - IM MH - Humans MH - Bundle-Branch Block/diagnosis/therapy/etiology MH - Stroke Volume MH - Contrast Media MH - Treatment Outcome MH - Electrocardiography MH - Gadolinium MH - *Heart Failure MH - *Ventricular Dysfunction, Left MH - Ventricular Function, Left MH - Bundle of His MH - Cardiac Pacing, Artificial/adverse effects OTO - NOTNLM OT - Guideline-directed medical therapy OT - Heart failure OT - Left bundle branch block OT - Left bundle branch pacing OT - Mildly reduced ejection fraction EDAT- 2023/07/27 01:09 MHDA- 2023/10/02 06:42 CRDT- 2023/07/26 19:21 PHST- 2023/05/26 00:00 [received] PHST- 2023/06/30 00:00 [revised] PHST- 2023/07/17 00:00 [accepted] PHST- 2023/10/02 06:42 [medline] PHST- 2023/07/27 01:09 [pubmed] PHST- 2023/07/26 19:21 [entrez] AID - S1547-5271(23)02545-6 [pii] AID - 10.1016/j.hrthm.2023.07.063 [doi] PST - ppublish SO - Heart Rhythm. 2023 Oct;20(10):1436-1444. doi: 10.1016/j.hrthm.2023.07.063. Epub 2023 Jul 24.