Application And Efficacy Of Left Bundle Branch-Optimized Resynchronization Therapy In Patients With Heart Failure

Objective:The efficacy and value of left bundle branch–optimized resynchronization therapy(LOT-CRT)for current clinical application were evaluated by comparing and analyzing the left ventricular ejection fraction(LVEF),ECG QRS duration,programcontrolled parameters and postoperative complications in patients with heart failure(HF)after cardiac resynchronization therapy with biventricular pacing(BVP-CRT)and LOTCRT.Methods: Patients who presented to our hospital for heart failure from September 2019 to September 2022 were enrolled using retrospective cohort study methods,and these patients met the(LVEF ≤35%,the QRS duration ≥130ms,and the NYHA cardiac function class II.-IV.was classified.According to the type of permanent pacing implanted,it was divided into two groups,namely the BVP-CRT group and the LOTCRT group,with 43 cases and 21 cases,respectively.The baseline information before operation,ECG QRS duration,left ventricular ejection fraction(LVEF),left atrial diameter(LAD),left ventricular end-diastolic inner diameter(LVEDD),programcontrolled parameters(including perception threshold,pacing threshold,impedance),and operationrelated complications such as perforation,electrode dislocation,pouch infection were collected at 6 and 12 months after operation between the two groups to evaluate the efficacy and value of LOT-CRT for patients with HF and LBBB.Results:1.In this study,a total of 64 patients were enrolled,consisting of 21 patients in the LOT-CRT group and 43 patients in the CRT group,and there was no significant difference in the baseline information of the two groups before surgery,including gender,age,history of hypertension and diabetes,ECG QRS wave duration,LVEF,LAD,LVEDD,and heart failure drug treatment.2.The operation time in the LOT-CRT group was significantly longer than that in the BVP-CRT group [(156.48±12.31)min vs.(125.28±11.94)min,(P<0.001)],and the exposure time was also extended [(33.10±4.80)min vs.(22.47±4.22)min,(P<0.001)].3.The QRS wave duration in the LOT-CRT group was narrower than that in the BVP-CRT group,and the differences were statistically significant at 3 months after surgery [(122.9±10.71)ms vs.(138.33±15.81)ms,P<0.001] and 6 months after surgery[121.67±10.79)ms vs.(134.07±17.91)ms,P=0.001].4.There were no significant differences in left atrial diameter between the LOTCRT group at three months and six months after surgery compared with the BVP-CRT group.There was no statistically significant difference between the two groups,and the left ventricular end-diastolic diameter at 3 months after surgery was significantly smaller than that at 6 months after surgery [(51.52±8.11)mm vs.(57.95±8.43)mm,P=0.005].5.The left ventricular ejection fraction [(42.19±9.56)% vs.(37.89±6.74)%,P=0.041] and the left ventricular ejection fraction [(47.10±10.23)%(41.60±8.92)%,P=0.031] at 3 months after surgery were higher in the LOT-CRT group than those in the BVP-CRT group,and the NYHA cardiac function grade at 3 months after surgery was[(2.19±0.81)vs.(2.67±0.64),P=0.012] and the NYHA cardiac function grade [(1.86±0.85)vs.(2.33±0.87)ms,P=0.045] at 6 months postoperative were also better than those in the BVP-CRT group.In the LOT-CRT group,there were 1 non-responder(4.8%)and 20(95.2%)responders,and in the BVP-CRT group,there were 13 nonresponders(30.2%)and 30(69.8%)reactive cases,and there was a statistical difference in the response rate between the two groups(P=0.046).In the LOT-CRT group,12patients(38.1%)had hyperreactions;In the BVP-CRT group,10 patients(23.3%)had hyperreactions,and the difference in hyperreaction rates between the two groups was statistically significant(P=0.007).6.There was 1 case of pericardial effusion,1 case of postoperative cystic hematoma,and 2 cases of postoperative electrode dislocation in the BVP-CRT group,and there was no significant difference in the incidence of postoperative complications between the two(P=1.000).The parameters such as perceived threshold,pacing threshold and impedance were relatively stable during postoperative follow-up,and there were no significant statistical differences.Conclusion:1.For HF patients,LOT-CRT can correct the patient’s cardiac desynchronization,narrow the QRS wave time,improve the patient’s left ventricular ejection fraction,and improve clinical symptoms,which is feasible,safe and effective.2.Compared with the BVP-CRT group,LOT-CRT can further narrow the QRS wave time limit,improve the left ventricular systolic function,and improve the CRT response rate,while not significantly increasing the risk of surgical complication,can be used as an alternative to the less effective BVP-CRT.