Predictors of failed left bundle branch pacing implant in heart failure with reduced ejection fraction: importance of left ventricular diameter and QRS morphology.

BACKGROUND

Left bundle branch pacing (LBBP) is considered an alternative to cardiac resynchronization therapy (CRT). However, LBBP is not suitable for all heart failure patients.

OBJECTIVE

The aim of our study was to identify predictors of unsuccessful LBBP implantation in CRT candidates.

METHODS

A cohort of consecutive patients with indications for CRT were included. Clinical, echocardiography and electrocardiography variables were prospectively recorded.

RESULTS

A total of 187 patients were included in the analysis. LBBP implantation was successful in 152/187 (81.2%) patients and failed in 35/187 (18.7%) patients. The causes of unsuccessful implantation were unsatisfactory paced QRS (28/35; 80%), inability to screw the helix (4/35; 11.4%), lead instability (2/35; 5.7%), and high pacing thresholds (1/35; 2.8%). The left ventricular end diastolic diameter (LVEDD), non-LBBB (left bundle branch block) QRS morphology, and QRS width were predictors of failed implantation according to the univariate analysis. According to the multivariable regression analysis, LVEDD [OR 1.31 per 5 mm increase (95% CI 1.05, 1.63) p=0.02] and non-LBBB [OR 3.07 (95% CI 1.08, 8.72) p=0.03] were found to be independent predictors of unsuccessful LBBP implantation. An LVEDD of 60 mm has 60% sensitivity and 71% specificity for predicting LBBP implant failure.

CONCLUSIONS

When LBBP was used as CRT, LVEDD and non-LBBB QRS morphology predicted unsuccessful implantation. Non-LBBB triples the likelihood of failed implantation independent of LVEDD. Caution should be taken when considering these parameters to plan the best pacing strategy for patients.

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Copyright © 2024. Published by Elsevier Inc.