Similar clinical outcomes were observed among men and women undergoing left bundle branch area pacing (LBBAP) for CRT, and men undergoing LBBAP had a lower risk of heart failure (HF)-related hospitalizations and all-cause mortality when compared to men undergoing biventricular pacing (BIVP), according to a study presented at Heart Rhythm 2024 and simultaneously published in JACC: Clinical Electrophysiology.

Usha B. Tedrow, MD, MSc, et al., set out to explore sex differences in response to LBBAP vs. BIVP for CRT, including a total of 539 patients (69.7% men, 30.3% women) with left ventricular ejection fraction (LVEF) ≤35% and LBBB or an LVEF ≤40% with an expected right ventricular pacing exceeding 40% undergoing initial CRT with LBBAP or BIVP. The composite primary outcome was HF-related hospitalization and all-cause mortality.

Results showed no significant difference in the primary outcome when comparing men vs. women undergoing CRT with LBBAP (p=0.46). Among the BIVP group, the primary outcome was more frequent in men than women (p=0.03).

The primary outcome occurred 29.9% in men undergoing LBBAP and jumped up to 46.5% of men undergoing BIVP (p=0.004), while the difference noted among women (24.14% for LBBAP and 36.2% for BIVP) was not statistically significant (p=0.23).

The authors also looked at all procedure-related complications, finding no significant differences by sex. The most common complications among the LBBAP group were lead dislodgement (7.1%) with 3.5% requiring reintervention, and device-related infections (2.7%). In the BIVP group, most common complications included lead dislodgement (4.8%), with all of them requiring reintervention, and phrenic nerve stimulation (4.2%).

“Despite being underrepresented in trials, female sex is recognized as a predictor of success in HF patients eligible for CRT using BIVP…” write the authors. “Our results showed that men undergoing LBBAP as the initial CRT strategy had a similar clinical outcome in comparison to women in the LBBAP and BIVP groups (p=0.46), overcoming the previously recognized sex differential response to BIVP.”

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Electrophysiology, Sex Characteristics, Cardiac Resynchronization Therapy

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