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Resynchronisation Strategies in CRT Upgrade: A Real-World Comparison Between LBBP and Biventricular Pacing
Session:
Sessão de Posters 53 - Otimização de CRT em 2026
Speaker:
Inês Brito E Cruz
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Inês Brito e Cruz; Maria João Primo; Didier Martinez; Diogo Fernandes; Carolina Saleiro; Patrícia Alves; Pedro Sousa; João André Ferreira; Natália António; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Background: </strong>Cardiac resynchronization therapy (CRT) is an established treatment for heart failure (HF) with electrical dyssynchrony. In patients with chronic right ventricular pacing requiring a CRT upgrade, resynchronization may be achieved with conventional biventricular pacing (BVP-CRT) or conduction system pacing, particularly left bundle branch pacing (LBBP-CRT). Although LBBP provides more physiological ventricular activation, real-world comparative data in upgrade cohorts are limited.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">This study compared echocardiographic and clinical outcomes following upgrade to LBBP-CRT versus BVP-CRT.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods: </strong>Retrospective observational analysis of consecutive CRT upgrade procedures performed in a tertiary centre between Oct/2022 and Sep/2025. Baseline demographic, rhythm, clinical and echocardiographic data were collected. The primary endpoint was improvement in left ventricular ejection fraction (ΔLVEF). Secondary endpoints included responder rate (ΔLVEF >5%), super-responder rate (ΔLVEF >14.5%), and HF–related emergency department (ED) visits. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results: </strong>A total of 68 CRT upgrades were analysed (42 LBBP-CRT, 26 BVP-CRT). Baseline characteristics were broadly similar between groups. Patients upgraded with LBBP-CRT were slightly older (73.7±9.5 vs 72.2±13.5 years), with comparable baseline rhythm distribution (sinus rhythm 60.0% vs 61.5%; atrial fibrillation 40.0% vs 38.5%), QRS duration (178.6±33.5 vs 174.9±30.4 ms), and LVEF (30.8±8.9% vs 29.5±6.3%). Echocardiographic follow-up was available in 21 patients, with mean total follow-up of 428 ± 248 days for LBBP-CRT and 579 ± 364 days for BVP-CRT. ΔLVEF was not significantly different between groups (8.23±12.26% vs 5.13±8.58%, p=0.54), despite a numerically greater improvement in the LBBP-CRT group. Responder rates (69.2% vs 50.0%, p=0.38) and super-responder rates (23.1% vs 25.0%, p = 0.92) were likewise comparable. HF-related ED visits were significantly less frequent with LBBP-CRT (13.0% vs 50.0%, p=0.018), with Cox regression showing a consistent trend toward reduced risk (HR 0.29, 95% CI 0.07–1.18, p=0.084).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusions: </strong>In this real-world CRT upgrade cohort, LBBP-CRT achieved reverse remodeling comparable to BVP-CRT, with similar responder and super-responder profiles despite a shorter follow-up. Notably, LBBP-CRT was associated with substantially fewer HF-related ED visits. These findings support LBBP-CRT as a safe and physiologically favourable alternative to BVP-CRT in patients undergoing CRT upgrade.</span></span></p>
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