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Targeting the Conduction System: LBBAP-CRT versus BiV-CRT in a real world cohort
Session:
Sessão de Comunicações Orais 15 – Instabilidade eléctrica e terapêuticas do sistema de condução: do pacing à tempestade arrítmica
Speaker:
Maria João de Brito Mesquita Belo e Primo
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Maria João Primo; Inês Brito e Cruz; Ana Luísa Silva; Didier Martinez; Rita Bertão Ventura; João André Ferreira; Natália António; Patrícia Alves; Pedro Sousa; Lino Gonçalves
Abstract
<p><strong>Background:</strong><br /> Conduction system pacing has emerged as an alternative strategy for delivering cardiac resynchronization therapy (CRT), with left bundle branch area pacing (LBBAP-CRT) showing increasing clinical adherence. Nonetheless, direct comparisons with conventional biventricular pacing (BiV-CRT) regarding functional recovery and remodeling remain scarce.</p> <p><strong>Objective:</strong><br /> To evaluate differences in CRT response and improvement in left ventricular ejection fraction (LVEF) between patients treated with LBBAP-CRT and those undergoing traditional BiV-CRT.</p> <p><strong>Methods:</strong><br /> We performed a retrospective observational analysis of consecutive patients receiving CRT between 2022 and 2024. Individuals were assigned to either LBBAP-CRT (n = 117) or BiV-CRT (n = 100). CRT response was defined as a ≥5% increase in LVEF. “Super-response” was classified as achieving LVEF superior to 50% or an absolute LVEF gain of more than 14.5% at 6-month follow-up. Comparative analyses employed chi-square tests, independent t-tests, and Mann–Whitney U tests as appropriate.</p> <p><strong>Results:</strong><br /> The study population included 217 patients with comparable baseline characteristics across groups, including age (73.0 ± 10.5 vs 70.9 ± 11.2 years, p = 0.155), sex distribution, NYHA functional class, cardiomyopathy etiology, atrial fibrillation, and baseline QRS morphology. Median follow-up differed significantly, being shorter in the LBBAP-CRT cohort (15.0 months, IQR 12.7) than in the BiV-CRT group (28.6 months, IQR 23.2).<br /> Although the LVEF improvement trend did not reach statistical significance on two-tailed testing (ΔLVEF 11.4% vs 6.7%, p = 0.056), patients receiving LBBAP-CRT demonstrated a markedly higher proportion of responders than those treated with BiV-CRT (83.8% vs 56.6%, p = 0.007). Rates of super-response were comparable between groups (24.3% vs 22.6%, p = 0.853).</p> <p><strong>Conclusion:</strong><br /> In this real-world experience, LBBAP-CRT resulted in a significantly greater proportion of patients achieving meaningful LVEF improvement compared with BiV-CRT, alongside a strong trend toward superior absolute LVEF gains. These data reinforce LBBAP as a promising modality for enhancing CRT efficacy, supporting the need for randomized prospective trials to validate these findings.</p>
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