Exploring Sex Differences in LBBAP vs. BIVP For CRT

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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