A long-term clinical comparative study of left bundle branch pacing versus biventricular pacing in patients with heart failure and complete left bundle branch block

Left bundle branch pacing (LBBP) is an emerging physiological pacing technique characterized by stable pacing parameters and a narrower QRS duration. This study aims to compare the long-term efficacy and safety of biventricular pacing (BIVP) and LBBP in patients with heart failure with reduced ejection fraction (HFrEF) and complete left bundle branch block (CLBBB). A retrospective analysis was conducted on 35 patients with chronic HFrEF accompanied by CLBBB treated at our center from April 2018 to October 2022. The patients were divided into two groups based on the surgical technique: the LBBP group and the BIVP group. Postoperative follow-up data were collected, including pacing parameters, QRS duration, echocardiographic indices (left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), mitral and tricuspid regurgitation), NT-proBNP levels, and New York Heart Association (NYHA) classification. n addition, postoperative complications, heart failure readmission rates, and mortality rates were observed. 35 patients were recruited, 18 for LBBP and 17 for BIVP. The LBBP group demonstrated significantly lower pacing thresholds and impedance at 12 months post-surgery compared to the BIVP group (p < 0.05). The QRS duration in the LBBP group was significantly narrower than that in the BIVP group at 6, 12, and 24 months (p < 0.05). At 24 months post-surgery, LVEDD and LVESD were significantly lower in the LBBP group than those in the BIVP group (p < 0.05). No significant differences were observed between groups in response rates, tricuspid and mitral regurgitation, NYHA class, NT-proBNP levels, all-cause mortality, or heart failure rehospitalization rates (p > 0.05). LBBP may be a relatively safe and effective resynchronization therapy, serving as a complementary approach to BIVP for patients with HFrEF and CLBBB.