Comparison of efficacy of left bundle branch area pacing and biventricular pacing in patients with dilated cardiomyopathy

Comparison of efficacy of left bundle branch area pacing and biventricular pacing in patients with dilated cardiomyopathy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Article Comparison of efficacy of left bundle branch area pacing and biventricular pacing in patients with dilated cardiomyopathy Qiang He, xiaoming li, xilin xu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3687439/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Left bundle branch area pacing (LBBAP) is a type of conduction system pacing (CSP), and is often used as an alternative to traditional biventricular pacing (BIVP).For patients with dilated cardiomyopathy, there is still a lack of comparison between the efficacy of LBBAP and BIVP, and the different efficacy of LBBAP in patients with left bundle branch block(LBBB) or atrioventricular block(AVB). Methods 124 patients with dilated cardiomyopathy were retrospectively collected and divided into LBBAP group (n = 66) and BIVP group (n = 58) according to different surgical methods. Preoperative electrocardiogram (ECG), echocardiogram, clinical cardiac function grading, intraoperative implantation parameters, and follow-up results at 1, 6, and 12 months after pacemaker implantation of all patients were collected. The two groups of data were compared and subgroup analysis was conducted to explore the different therapeutic effects of LBBAP on patients with CLBBB and patients with AVB respectively. Results Compared with BIVP, LBBAP produces lower and stable pacing threshold and shorter operation time. LBBAP reduced QRSd significantly more than BIVP (47.65 ± 17.94 vs 24.41 ± 15.80 ms, p < 0.001). It should be emphasized that LBBAP and BIVP improved left ventricular ejection fraction(LVEF), left atrial diameter(LAD), left ventricular internal diameter at end-diastole(LVIDD) and New York Heart Association(NYHA) class of patients with dilated cardiomyopathy compared with baseline, but LBBAP improved more significantly than BIVP. In addition, the number of readmissions of patients receiving LBBAP was significantly lower than that of BIVP group (p = 0.004). Subgroup analysis showed that the improvement of cardiac function was related to the correction of electrical conduction asynchrony; In the LBBAP group, the improvement of LVIDD in CLBBB patients was significantly higher than that in AVB patients (11.30 ± 7.24mm vs. 6.61 ± 5.54 mm). Conclusions Compared with BIVP, LBBAP can better optimize electrical synchronization and improve cardiac function and clinical outcome and can be the first choice for patients with cardiac conduction pathway block. LBBAP has a better effect on improving left ventricular structure in patients with CLBBB than in patients with AVB. Health sciences/Cardiology Health sciences/Diseases Health sciences/Medical research cardiac resynchronization therapy dilated cardiomyopathy left bundle branch area pacing biventricular pacing complete left bundle branch block Atrioventricular block. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Dilated cardiomyopathy (DCM) is a primary myocardial disease with unknown causes, and its final stage is heart failure (HF). The degree of cardiac dyssynchrony is an independent predictor of sudden cardiac death and increased mortality in patients with heart failure [1] .Recent studies suggested that left bundle branch block(LBBB)-induced cardiomyopathy emerges as a distinct pathological entity [2–3] . For patients with atrioventricular block(AVB), inappropriate pacing may induce cardiomyopathy [4] or increase the risk of heart failure(HF) admission [5] .In terms of current pacing methods, the procedure of biventricular pacing(BIVP) is complicated, especially for patients with tortuous vessels or coronary sinus ostium malformation. In addition, In addition, relevant studies have found that about 20–40% of patients are not suitable for using BIVP [6] .His-Purkinje system pacing(HBP) is currently considered the optimal physio-logic pacing method [7] . However, high pacing threshold, low ventricular signal perception and technical difficulties can limit the application of HBP [8] .Intraseptal left bundle branch area pacing (LBBAP) is a novel technique to pace the conduction system beyond the site of block and is associated with low and stable capture thresholds [9–10] . Recently LBBAP has been shown to restore left ventricle(LV) synchrony in patients with LBBB [11] . LBBAP has the potential advantage of backup LV septal capture in addition to left bundle branch (LBB) capture in these patients. In addition, LBBAP also showed significant advantage in improving cardiac function in patients with atrioventricular block with high ventricular pacing burden [12] . The aims of the study were to: 1) investigate the feasibility and safety of LBBAP in the treatment of DCM patients, and compare the clinical efficacy of LBBAP and BIVP, and 2) explore the different effects of LBBAP on DCM patients with CLBBB or atrioventricular block. Methods Study patients The hospitalized patients, diagnosed with DCM, were enrolled at the Shanxi Cardiovascular Disease Hospital from December 2018 to June 2022,and each patient received LBBAP or BIVP treatment. Inclusion criteria (One of them is enough) : Patients with symptomatic heart failure with sinus rhythm, QRS duration (QRSd) > 130ms, LBBB or non LBBB, and LVEF ≤ 35%; And optimized drug therapy for 3 months or more; 2. Sinus rhythm frequency 3.0 seconds, or electrocardiogram showing second degree II, high degree, and third degree atrioventricular block, and symptoms caused by bradycardia, such as weakness, dizziness, dark outside, fainting, etc. The exclusion criteria were patients with valvular heart disease, coronary heart disease, congenital heart disease, or patients with a life expectancy of less than 1 year(Fig. 1 ). This study was approved by the Ethics Committee of Shanxi Cardiovascular Hospital.We confirm that all methods are carried out in accordance with relevant guidelines and regulations.Each patient signed the relevant informed consent form upon admission DCM Dilated cardiomyopathy, HF Heart Failure, CLBBB Complete Left Bundle Branch Block, NYHA New York Heart Association, LBBAP Left Bundle Branch Area Pacing, BIVP Biventricular Pacing, LVEF Left Ventricular Ejection Fraction, LAD Left Atrial Dimension, LVIDD Left Ventricular Internal Diastolic Dimension. Implantation procedure Left bundle branch area pacing LBBAP was implemented using the 3830-pacing lead and C315 His sheath (Select Secure, 69 cm; C315 His sheath, Medtronic, Inc., Minneapolis, MN). LBBAP lead was initially placed in the typical his-bundle pacing area, as described in the HBP implantation method [7,13] .As shown in Fig. 2 , under the right anterior oblique (RAO) perspective, the C315 sheath passes through the tricuspid annulus. Move the tip to the right ventricular septal area 1.5-2 cm away from the tricuspid annulus and output unipolar pacing. When the V1 QRS wave is W-shaped, it can serve as an ideal insertion point for the lead. In the left anterior oblique position (LAO), the pacemaker lead rotates to the interventricular septum, during which intermittent pacing is performed. When the QRS mode of the electrocardiogram is RBBB or similar to the normal QRS mode, and the QRS duration narrows, it is considered that the lead has reached the appropriate position. Finally, the pacing threshold and lead impedance were tested and the sheath was removed(Fig. 2 A, B). The criteria of the correction of CLBBB by LBBAP was characterized [14] by followings :(1) CLBBB morphology disappeared and a QR or rSR morphology in surface lead V1 was achieved. Paced QRS became narrow; (2) short average ventricular activation time (LVAT); 3) The position of lead tip was under the sub-endocardium of interventricular septum. Biventricular pacing BIVP was a technique for performing CRT. The lead tip in right ventricle was located at the apex of the right ventricle. According to the judgment of the operator, the right atrial lead was placed in the right atrial appendage or outside the right atrium. The left ventricular lead was placed on the posterolateral or lateral wall of LV with the help of coronary sinus angiography. The atrioventricular sequential pacing for BIVP was performed by equipment(Fig. 2 C, D). Data collection and follow-up Before operation, baseline patient demographics, medical history, current medications, and electrocardiographic and echocardiographic findings were collected. LBB and BIV capture thresholds and pacing impedances were obtained at implantation and during device follow-up examinations. During the operation, we recorded procedure time and unipolar tip pacing thresholds and impedances of LBBAP or BIVP. Patients underwent regular follow-up at 1months,6months, and12months postimplantation in the hospital outpatient and device clinic, at the follow-up visit, ECG, capture threshold, and pacing impedance, were collected. Standard echocardiographic indices, including LVEF, LAD, and LVIDD, were acquired. We also documented NYHA class, and tracked complications and clinical outcomes, such as death and rehospitalization. Statistical analysis Values are expressed as numbers and percentages for categorical variables and as mean ± standard deviations (SDs) for continuous variables. Comparison categorical data was accomplished using the chi-squaredor Fisher's exact test, Comparisons of continuous variables were carried out using two-tailed Student’s t-or rank-sum tests. All statistical analyses were performed using SPSS soft-ware version 26.0, A p value of < 0.05 was considered to indicate statistical significance. Results Baseline characteristics As shown in Table 1 ,a total of 124 hospitalized patients with DCM were enrolled and followedupfor a mean duration of 11.98 ± 2.88 months, of which 66 underwent LBBAP (mean 63.67 ± 9.82 years, 71.21% males) while 58 received BIVP (mean 62.53 ± 12.83 years, 77.59% males).63 patients underwent LBBAP as the first-line strategy. In 3 patients, LBBAP was used as a rescue attempt after failed coronary sinus lead placement. All patients had DCM at baseline, There were no significant differences between these two groups (Table 1 ). All patients received optimized medical therapy including diuretic,β-blockers, angiotensin-converting enzyme inhibitor or angiotensin receptor antagonist, and aldosterone receptor antagonist. and were followed-up at 1-, 6-, and 12-month after pacing. Table 1 Baseline characteristics of patients who underwent LBBAP and BIVP Parameters LBBAP group (n = 66) BIVP group (n = 58) p value Male, n % 47 (71.21) 45 (77.59) 0.418 Age, years 63.67 ± 9.82 62.53 ± 11.83 0.562 Medical comorbidities Hypertension, n % 33 (50.00) 24 (41.38) 0.337 Diabetes mellitus, n % 19 (28.79) 20 (34.48) 0.496 Renal dysfunction, n % 13 (19.70) 13 (22.41) 0.711 Atrial fibrillation, n % 16 (24.24) 15 (25.86) 0.835 hyperlipidemia, n % 10 (15.15) 7 (12.07) 0.619 CLBBB, n % 38(57.58) 32(55.17) 0.788 Atrioventricular block, n % 21 (31.82) 18 (31.03) 0.925 QRSd, ms 175.83 ± 23.86 177.78 ± 21.49 0.636 Echocardiography parameters LVEF, % 27.94 ± 6.82 28.31 ± 6.58 0.759 LAD, mm 47.12 ± 6.35 46.84 ± 4.77 0.783 LVEDD, mm 69.35 ± 12.05 68.64 ± 9.86 0.722 NYHA NYHA class II, n % 15 (22.73) 11 (18.97) 0.608 NYHA class III, n % 33 (50%) 32 (56.90) 0.565 NYHA class IV, n % 18 (27.27) 15 (25.86) 0.859 NYHA class 3.05 ± 0.71 3.07 ± 0.67 0.851 Drug therapy Diuretic, n % 50 (75.76) 47 (81.03) 0.477 ACEI/ARB/ARNI, n % 59 (89.39) 51 (97.93) 0.797 Beta-blocker, n % 56 (84.85) 52 (89.66) 0.426 Aldosterone antagonist, n % 56 (84.85) 47(81.03) 0.572 ACEI angiotensin-converting enzyme inhibitor, ARB angiotensin II receptor blocker, ARNI angiotensin receptor-neprilysin inhibitor. Other abbreviations are as in Fig. 1 LBBAP and BIVP lead parameters As shown in Table 2 , LBBAP resulted in significantly shorter procedural time (109.50 ± 15.26 vs. 130.07 ± 20.28 min, p༜ 0.001).Acute lead parameters including capture thresholds at pulse width of 0.5 ms, pacing impedances and R-wave amplitudes were 0.78 ± 0.20V、635.64 ± 114.66Ωand8.95 ± 2.38mV.respectively. In addition, at implantation, the capture threshold of 3830 lead of LBBAP was lower than that of LV lead of BIVP, and these differences persisted at 1, 6, and 12 months of follow-up (Table 2 ). However, we found no significant differences in pacing impedance between the LBBAP and BIVP groups at implantation or follow-up (Table 2 ). During follow-up, both LBBAP and BIVP showed a slight decrease in capture threshold and pacing impedance, but still remained stable. Echocardiography showed that the pacing lead was positioned at the sub-endocardium of Interventricular septum in all patients. No perforation into LV cavity or pericardial effusion was observed. Table 2 Pacing parameters of patients in the LBBAP and BIVP groups Procedural characteristics LBBAP group (n = 66) BIVP group (n = 58) p value Pacing types, n% ICD 0(0) 1(1.72) 0.468 CRT-P 32(48.48) 20(34.48) 0.115 CRT-D 34(51.52) 37(65.52) 168 Procedural time, min 109.50 ± 15.26 130.07 ± 20.28 0.000 R-wave amplitude, mV 8.95 ± 2.38 10.30 ± 1.78 0.001 Pacing parameters LV or 3830 lead impedance, Ω At implant 635.64 ± 114.66 662.02 ± 116.71 0.207 1-month follow-up 640.60 ± 119.01 659.43 ± 113.50 0.381 6-month follow-up 631.78 ± 116.99 664.17 ± 123.27 0.171 12-month follow-up 637.42 ± 113.30 662.96 ± 113.95 0.234 LV or 3830 lead thresholds, at 0.5 ms, V At implant 0.78 ± 0.20 1.01 ± 0.29 0.000 1-month follow-up 0.76 ± 0.22 1.03 ± 0.24 0.000 6-month follow-up 0.76 ± 0.21 1.00 ± 0.25 0.000 12-month follow-up 0.71 ± 0.19 0.99 ± 0.26 0.000 Changes in QRS duration Overall, the baseline and follow-up QRSd data of LBBAP group and BIVP group showed that the QRSd of 12-lead ECG in both groups was significantly reduced (Fig. 3 A).Specifically, the duration of QRS in LBBAP group significantly decreased from a baseline 175.83 ± 23.86 ms to 128.18 ± 12.95 ms(p < 0.001),and the QRSd of 58 patients in the BIVP group decreased from baseline 177.78 ± 21.49 to 153.53 ± 13.43ms(p < 0.001)(Fig. 3 B).Although QRS duration decreased in patients with LBBAP and BIVP compared with baseline, this reduction was greater in patients with LBBAP (47.65 ± 17.94 vs24.41 ± 15.80 ms,p < 0.001 ) (Fig. 3 C). Changes in echocardiographic measurements(simpson measurement method) As shown in Fig. 4 ,patients in both groups exhibited significantly improved LAD, LVIDD, and LVEF in both LBBAP and BIVP from baseline to follow-up of 12-month.In LBBAP group, LAD decreased from 47.12 ± 6.35mm to 39.02 ± 4.64mm (P < 0.001), LV ID D decreased from 69.35 ± 12.05mm to 57.98 ± 9.26mm (P < 0.001), and LVEF increased from27.94 ± 6.82% to 44.55 ± 6.46% during 12-month follow-up (P < 0.001) (Figure.4ABC).In BIVP group, LAD decreased from 46.84 ± 4.77mm to 42.98 ± 5.84mm (P < 0.001), LVIDD decreased from 68.64 ± 9.86mm to 62.09 ± 7.75mm (P < 0.001), and LVEF increased from 28.31 ± 6.58% to 37.30 ± 5.67% (P < 0.001) after 12-month follow up (Figure.4ABC). In addition, 7 out of 66 patients in the LBBAP group and 2 out of 58 patients in BIVP group exhibited super-response(LVEF༞50%), although the super-response rate did not significantly differ between LBBAP and BIVP group (10.61% vs. 3.45%,p = 0.172).The improvement of LVEF was greater in the LBBAP group than that in the BIVP group (16.68 ± 8.27% vs 8.94 ± 6.39%, p < 0.001). The improvement in other echocardiographic parameters such as LAD (8.12 ± 6.78mm vs. 3.89 ± 5.45mm, P < 0.001) and LVIDD (11.30 ± 7.24mm vs. 6.61 ± 5.54mm, P < 0.001)were similar to the changes in LVEF. Changes in clinical cardiac function As shown in Figure 5 ,NYHA classification significantly decreased in both groups. In LBBAP group, the percentage of patients with NYHA grade I increased from 0 to 39.4%, and the percentage of grade II increased from 22.7–36.4%. LBBAP decreased NYHA class at the 12-month follow-up compared with baseline (3.05 ± 0.71 ~ 1.91 ± 0.91,p < 0.001). In BIVP group, the percentage of patients with NYHA grade I increased from 0 to 6.9%, and the percentage of grade II increased from 19.0–53.45%. BIVP decreased NYHA class at the 12-month follow-up compared with baseline (3.07 ± 0.67 ~ 2.33 ± 0.60, p༜0.001).Overall, NYHA classification significantly decreased in both groups, and the percentage of patients in NYHA classification grade I and II was significantly higher in the LBBAP group compared to that in the BIVP group. Association of CLBBB correction and improved cardiac function As shown in Table 1 ,there were 38 patients with CLBBB in the LBBAP group and 32 in the BIVP group. In the LBBAP group, complete correction of the LBBB (QRSd ≤ 130 ms) was achieved in 16 patients. However, in the BIVP group, only 1 patient achieved QRSd ≤ 130ms.Obviously, the proportion of patients with CLBBB whose QRSd rhythm ≤ 130 ms was significantly higher in the LBBAP group than in the BIVP group (16/38 vs 1/32, p < 0.001).In conclusion, the effective rate of LBBAP in the complete correction of CLBBB is much higher than that of BIVP. We further compared the duration of QRS in patients with CLBBB correction in the LBBAP group with those with CLBBB failure. We found that the duration of QRS in patients with complete correction of CLBBB was lower than that in patients with CLBBB failure (116.06 ± 13.14 vs. 138.82 ± 5.50 ms, p < 0.001).They are both much smaller than the initial QRSd of CLBBB correction(175.83 ± 23.86 ms)༈Figure 6 A ༉ .This still indicated that the effectiveness of LBBAP in the treatment of patients with DCM with CLBBB. In addition, Subgroup analysis found that the proportion of LVEF ≥ 45% in patients with QRSd ≤ 130 ms in LBBAP group was significantly higher than that in patients with QRSd > 130 ms (QRSd > 130 ms) (25/38 vs 9/28, p = 0.007)༈Figure 6 B ༉ .The subgroup analysis suggested that the improvement of LVEF was correlated with the complete correction of CLBBB. However, no such phenomenon was found in LAD and LVIDD. Atrioventricular block correction is associated with improved cardiac function As shown in Table 1 ,there were 21 patients with atrioventricular block in the LBBAP group and 18 in the BIVP group. In the LBBAP group, correction of the atrioventricular block (QRSd ≤ 130 ms) was achieved in 14 patients. However, in the BIVP group, only 1 patient achieved QRSd ≤ 130ms.Obviously, the proportion of patients with atrioventricular block whose QRSd rhythm ≤ 130 ms was significantly higher in the LBBAP group than in the BIVP group (14/21 vs 1/18, p༜0.001).In conclusion, the effective rate of LBBAP in the correction of atrioventricular block is much higher than that of BIVP. Both LBBAP and BIVP shortened 12-lead ECG QRSd in patients with DCM complicated with atrioventricular block, but the QRSd of LBBAP group were significantly narrower than those of BIVP group(126.81 ± 11.32 vs 153.72 ± 17.77 ms, p < 0.001) .Additionally, Analysis of different follow-up periods showed that 8 patients with atrioventricular block correction exhibited higher LVEF(47.21 ± 5.52 vs. 35.08 ± 8.53%, p༜0.001), lower LAD(38.21 ± 4.39vs. 45.25 ± 8.73 mm, p = 0.021), and lower LVIDD(54.50 ± 6.48vs. 63.42 ± 12.43 mm, p = 0.028) compared to the 5 patients with atrioventricular block at 12-month follow-up .These results further demonstrated that atrioventricular block correction was associated with improved cardiac function. To sum up, we found that LBBAP is better than BIVP in CLBBB and AVB patients. Further investigating the difference of curative effect between CLBBB patients and AVB patients, it was found that there was no statistically significant difference in the improvement of LVEF, LAD and cardiac function grading between the two groups (P > 0.05),but the improvement of LVIDD(13.45 ± 5.89mm vs. 9.33 ± 8.22mm p = 0.030)and QRSd(51.26 ± 16.69 vs 42.29 ± 12.26 ms, p = 0.035) in CLBBB patients was significantly higher than that in AVB patients. Clinical outcomes During the 12-month follow up period, we tracked complications and clinical outcomes, such as death and re-hospitalization. Two patients in the LBBAP group ware readmitted to the hospital with HF, and one patient was readmitted for pacemaker lead adjustment. In the BIVP group, four patients were readmitted because of worsening HF and one patient died. Among the 4 readmission patients, 1 patient was readmitted 2 times, 1 patient was readmitted 3 times, and 1 patient was readmitted 5 times. This indicated that the number of hospitalizations in the LBBAP group was significantly lower than that in the BIVP group (p = 0.004),which suggested that the rate of rehospitalization in the LBBAP group was significantly lower than that in the BIVP group. Discussion The main findings of this retrospective, observational study are as follows:1. This study demonstrated the feasibility and safety of LBBAP in the treatment of patients with DCM, and was associated with few adverse outcomes;2.Both LBBAP and BIVP can improve the QRSd, LVEF,LAD,LVIDD, NYHA class and other cardiac function indexes in patients with DCM, and the degree of improvement of LBBAP is more obvious than that of BIVP;3.Compared with BIVP, LBBAP can successfully correct CLBBB and AVB, and is feasible as an alternative to CRT;4.QRSd can be used as independent predictors of cardiac function and clinical adverse reactions in patients with DCM. Many studies [15–19] and our study have shown that LBBAP was safe and feasible. Our study and many studies [16,20–23]] have further demonstrated that LBBAP was associated with few adverse outcomes or very mild complications, and the rehospitalization rate was significantly lower than that of BIVP group. Previous studies [14,21] have shown that LBBAP can significantly shorten QRSd. In our study, both LBBAP and BIVP can significantly reduce QRSd, and the degree of LBBAP reducing QRSd was particularly significant. The decrease of cardiac function and the occurrence of clinical adverse reactions may be related to the enlargement of the heart cavity,this can also be seen in the study of Adhyapak [24] . For example, when left ventricular dilation increases significantly, LVEF decreases, pulmonary artery systolic blood pressure (PASP) and greater diatolic dysfunction increase, and the number of readmissions and deaths also increases significantly. Previous study have found that there was a strong correlation between the prolongation of the peak time of left ventricular pressure rise and cardiac dyssynchrony before ejection [25] , and the decline of cardiac function may be related to ventricular electrical asynchrony. From our research, we can see that LBBAP has a more obvious role in reverse remodeling of cardiac structure than BIVP and can significantly reduce LAD and LVIDD. Therefore, the advantages of LBBAP may be related to its ability to provide more physiological ventricular activation modes, generate better electrical and mechanical resynchronization [26–29] , and may have beneficial effects on left atrial function by reducing LAD in patients with high ventricular pacing load. In contrast, the left ventricular electrode of BIVP reaches the epicardium of the left ventricle through the target vein. The cardiac excitation is from the epicardium to the endocardium, and non-physiological pacing is carried out in the left and right ventricles, thus prolonging the left ventricular activation time [30–31] . In general, LBBAP is superior to BIVP in improving electrocardiogram and echocardiography results. We try to find out the different effects of LBBAP in different patients. Specifically, it is the different effects of LBBAP on patients with cardiac insufficiency and left bundle branch block or atrioventricular block. In our study, 65.79% of CLBBB patients in the LBBAP group achieved complete correction (QRSd < 130ms), which is lower than the success rate of complete correction of CLBBB by LBBAP in previous studies [9,32] , which may be related to the complications of patients and the experience of operators. The report of Upadhyay GA [33] suggested that some types of LBBB cannot be corrected with His-Purkinje system pacing, such as left ventricular slow conduction caused by myocardial injury, and conduction disorder caused by scar or distal branch of left bundle branch [34] . Researches in recent years suggested that [9,35] LBBAP was a safe and effective resynchronization method for patients with cardiac insufficiency and electrical asynchrony, which can achieve the same clinical effect as CRT. Our research results demonstrated that the improvement of cardiac function is related to the correction of CLBBB and AVB.From this study, it can be seen that LBBAP significantly improves QRSd and LVIDD in CLBBB patients compared to AVB patients. LBBAP has a more significant improvement effect on CLBBB patients than AVB patients. LBBAP, as a novel physiological pacing mode, can directly pace the final pathway of the cardiac electrical conduction pathway across the blocked part. It can be the first choice for patients with cardiac electrical conduction pathway block, and can also be a candidate for patients with difficulty in implanting left ventricular leads or no response after implantation during BIVP surgery. Some articles [14,21] and our research have reached the same conclusion: LBBAP is a cardiac synchronization therapy method that can replace BIVP. The characteristics of our study are as follows: (1) This study focused on the treatment of LBBAP in patients with DCM, and compared the efficacy of LBBAP and BIVP; (2) We found that patients with successful correction of CLBBB and AVB achieved better clinical efficacy, and QRSD could be used as independent predictors of cardiac function and clinical adverse reactions in patients with DCM; (3) In a subgroup analysis of patients with DCM with CLBBB or AVB, we found that LBBAP improved left ventricular structure and QRSd significantly better in patients with CLBBB than in patients with AVB. However, our research needs more sample size and longer follow-up time to verify. Limitations and risks There are some limitations in this study. Firstly, the follow-up time is relatively short, and there is a lack of BNP, fluoroscopy time, hemodynamic monitoring, and other data. Secondly, although the total number of cases has reached a certain number, the number of cases during subgroup analysis is very small, and the conclusions drawn still need more research to verify. Of course, there are also some safety issues with LBBAP itself, such as the risk of thrombosis when acute and late perforation of the left ventricle occurs deep in the septum, and the lead tip is exposed to the left ventricle for a long time. Although Zhong's research [36] indicated that the occurrence of acute ventricular septal perforation could be reduced by determining the time to stop tightening the lead by the peak value of the R wave in the V5 lead, other risks remained unsolved. In addition, the existing literature has not been studied for a long time and cannot obtain long-term efficacy results. Conclusions To sum up, LBBAP is feasible and safe for the treatment of patients with dilated cardiomyopathy and is only associated with few adverse outcomes or very slight complications. LBBAP has more obvious effect on improving ventricular electrical synchronization, cardiac function and clinical response than BIVP, and can promote LA and LV reverse remodeling. LBBAP can be used as the first choice for patients with cardiac electrical conduction pathway block, and also as an alternative for patients with difficulty in implanting left ventricular electrode during BIVP or no response after implantation. Declarations AUTHOR CONTRIBUTIONS Study concept and design: Qiang He and Xiaoming Li. Analysis and interpretation of data: Qiang He, Xiaoming Li, Xilin Xu. Drafting of the manuscript: Qiang He and Xiaoming Li. Critical revision of the manuscript for important intellectual content: Qiang He, Xiaoming Li and Xilin Xu. Statistical analysis: Qiang He. Approval of the article: Qiang He, Xiaoming Li, Xilin Xu. ACKNOWLEDGMENTS Thanks to the Shanxi Cardiovascular Hospital,Chengdu BOE Hospital and the Graduate School of Shanxi Medical University for technical support of this study. CONFLICT OF INTEREST The authors declare no conflict of interest. DATA AVAILABILITY STATEMENT The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. References Prinz C, Lehmann R, Schwarz M, et al. - Left ventricular dyssynchrony predicts clinical response to CRT - a long-term follow-up single-center prospective observational cohort study[J]. Echocardiography, 2013, 30(8): 896–903. Sanna GD, De Bellis A, Zecchin M, et al. - Prevalence, clinical and instrumental features of left bundle branch block-induced cardiomyopathy: the CLIMB registry[J]. ESC Heart Fail, 2021, 8(6): 5589-93. Sanna GD, Merlo M, Moccia E, et al. - Left bundle branch block-induced cardiomyopathy: a diagnostic proposal for a poorly explored pathological entity[J]. Int J Cardiol, 2020, 299: 199–205. Kiehl EL, Makki T, Kumar R, et al. - Incidence and predictors of right ventricular pacing-induced cardiomyopathy in patients with complete atrioventricular block and preserved left ventricular systolic function[J]. Heart Rhythm, 2016, 13(12): 2272-8. Mittal S, Musat DL, Hoskins MH, et al. - Increased healthcare utilization associated with complete atrioventricular block in pacemaker patients[J]. J Interv Card Electrophysiol, 2018, 51(3): 221-8. Boogers MM, Van Kriekinge SD, Henneman MM, et al. - Quantitative gated SPECT-derived phase analysis on gated myocardial perfusion SPECT detects left ventricular dyssynchrony and predicts response to cardiac resynchronization therapy[J]. J Nucl Med, 2009, 50(5): 718 − 25. Huang W, Su L, Wu S, et al. - Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block[J]. Heart, 2019, 105(2): 137 − 43. Subzposh FA, Vijayaraman P. - Long-Term Results of His Bundle Pacing[J]. Card Electrophysiol Clin, 2018, 10(3): 537 − 42. Vijayaraman P, Subzposh FA, Naperkowski A, et al. - Prospective evaluation of feasibility and electrophysiologic and echocardiographic characteristics of left bundle branch area pacing[J]. Heart Rhythm, 2019, 16(12): 1774-82. Zhang S, Zhou X, Gold MR. - Left Bundle Branch Pacing: JACC Review Topic of the Week[J]. J Am Coll Cardiol, 2019, 74(24): 3039-49. Hou X, Qian Z, Wang Y, et al. - Feasibility and cardiac synchrony of permanent left bundle branch pacing through the interventricular septum[J]. Europace, 2019, 21(11): 1694 − 702. Li X, Zhang J, Qiu C, et al. - Clinical Outcomes in Patients With Left Bundle Branch Area Pacing vs. Right Ventricular Pacing for Atrioventricular Block[J]. Front Cardiovasc Med, 2021, 8(685253): 685253. Vijayaraman P, Dandamudi G. - How to Perform Permanent His Bundle Pacing: Tips and Tricks[J]. Pacing Clin Electrophysiol, 2016, 39(12): 1298 − 304. Wang Y, Gu K, Qian Z, et al. - The efficacy of left bundle branch area pacing compared with biventricular pacing in patients with heart failure: A matched case-control study[J]. J Cardiovasc Electrophysiol, 2020, 31(8): 2068-77. Chen K, Li Y, Dai Y, et al. - Comparison of electrocardiogram characteristics and pacing parameters between left bundle branch pacing and right ventricular pacing in patients receiving pacemaker therapy[J]. Europace, 2019, 21(4): 673 − 80. Li X, Li H, Ma W, et al. - Permanent left bundle branch area pacing for atrioventricular block: Feasibility, safety, and acute effect[J]. Heart Rhythm, 2019, 16(12): 1766-73. Chen Z, Zhou X, Ma X, et al. - Recruitment of the cardiac conduction system for optimal resynchronization therapy in failing heart[J]. Front Physiol, 2022, 13(1045740): 1045740. Jiang Z, Chen Y, Chen C, et al. - Feasibility and safety of left bundle branch area pacing in very elderly patients (≥ 80 years)[J]. Kardiol Pol, 2022, 80(4): 452 − 60. Heckman LIB, Luermans JGLM, Jastrzębski M, et al. - A single-centre prospective evaluation of left bundle branch area pacemaker implantation characteristics[J]. Neth Heart J, 2022, 30(5): 249 − 57. Jastrzębski M, Kiełbasa G, Cano O, et al. - Left bundle branch area pacing outcomes: the multicentre European MELOS study[J]. Eur Heart J, 2022, 43(40): 4161-73. Hua J, Chen Y, Yu J, et al. - Long-term outcomes of left bundle branch area pacing versus biventricular pacing in patients with heart failure and complete left bundle branch block[J]. Heart Vessels, 2022, 37(7): 1162-74. Liu X, Li W, Zeng J, et al. - Evaluation of clinical safety and efficacy of left bundle branch area pacing in comparison with right ventricular septal pacing[J]. Medicine, 2022, 101(11). Sharma PS, Patel NR, Ravi V, et al. - Clinical outcomes of left bundle branch area pacing compared to right ventricular pacing: Results from the Geisinger-Rush Conduction System Pacing Registry[J]. Heart Rhythm, 2022, 19(1): 3–11. Adhyapak SM, Thomas T, Jose MT, et al. - Effect of left ventricular geometric remodeling on restrictive filling pattern and survival in ischemic cardiomyopathy[J]. Indian Heart J, 2022, 74(3): 206 − 11. Odland HH, Villegas-Martinez M, Ross S, et al. - Shortening of time-to-peak left ventricular pressure rise (Td) in cardiac resynchronization therapy[J]. ESC Heart Fail, 2021, 8(6): 5222-36. Zhang W, Chen L, Zhou X, et al. - Resynchronization effects and clinical outcomes during left bundle branch area pacing with and without conduction system capture[J]. Clin Cardiol, 2023, 3(10): 23969. Zhu H, Wang Z, Li X, et al. - Medium- and Long-Term Lead Stability and Echocardiographic Outcomes of Left Bundle Branch Area Pacing Compared to Right Ventricular Pacing[J]. J Cardiovasc Dev Dis, 2021, 8(12). Mei Y, Han R, Cheng L, et al. - Assessment of Cardiac Function and Ventricular Mechanical Synchronization in Left Bundle Branch Area Pacing by Speckle Tracking and Three-Dimensional Echocardiography[J]. Am J Cardiol, 2023, 187: 1–9. Wang S, Lan R, Zhang N, et al. - LBBAP in patients with normal intrinsic QRS duration: Electrical and mechanical characteristics[J]. Pacing Clin Electrophysiol, 2021, 44(1): 82–92. Curtis AB, Worley SJ, Adamson PB, et al. - Biventricular pacing for atrioventricular block and systolic dysfunction[J]. N Engl J Med, 2013, 368(17): 1585-93. Ploux S, Whinnett Z, Lumens J, et al. - Acute hemodynamic response to biventricular pacing in heart failure patients with narrow, moderately, and severely prolonged QRS duration[J]. Heart Rhythm, 2012, 9(8): 1247-50. Huang W, Wu S, Vijayaraman P, et al. - Cardiac Resynchronization Therapy in Patients With Nonischemic Cardiomyopathy Using Left Bundle Branch Pacing[J]. JACC Clin Electrophysiol, 2020, 6(7): 849 − 58. Upadhyay GA, Cherian T, Shatz DY, et al. - Intracardiac Delineation of Septal Conduction in Left Bundle-Branch Block Patterns[J]. Circulation, 2019, 139(16): 1876-88. Li X, Fan X, Li H, et al. - ECG patterns of successful permanent left bundle branch area pacing in bradycardia patients with typical bundle branch block[J]. Pacing Clin Electrophysiol, 2020, 43(8): 781 − 90. Zu L, Wang Z, Hang F, et al. - Cardiac resynchronization performed by LBBaP-CRT in patients with cardiac insufficiency and left bundle branch block[J]. Ann Noninvasive Electrocardiol, 2021, 26(6): 12898. Zhong J, Zheng N, Jiang L. - Evaluation of the shortening of the stimulus-to-peak left ventricular activation time at continuous low output to confirm left bundle branch capture[J]. Heart Rhythm O2, 2022, 3(4): 351-7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3687439","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":260028899,"identity":"5e1b511d-9bb8-42b3-95ec-3de222da9d41","order_by":0,"name":"Qiang He","email":"","orcid":"","institution":"boe hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Qiang","middleName":"","lastName":"He","suffix":""},{"id":260028900,"identity":"645dda67-7915-4763-9424-2c78a25a6ec0","order_by":1,"name":"xiaoming li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYBACef7mgw8+GNgw87M3HyBOi+GMY8mGMwrS2CV7jiUQac2BHDNpng+H+Q1u5BgQp4Ox4QBQiwGzNFDLxxtvGOzkdBsIaGFnbki2nGPAZix55u1myzkMycZmBwjbcvDGGwOeZL7judukeRgOJG4jpAWopkGCx0CivuFAzjNitSQzSfIYGDALnMhhI04LMJCZDWcYJDADA9kY6Cki/CLP3//xwYc//0FR+fDGmwo7OYJaUADQU6Qoh2ghVccoGAWjYBSMCAAA1MpGUW64DS4AAAAASUVORK5CYII=","orcid":"","institution":"Shanxi Cardiovascular Disease Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"xiaoming","middleName":"","lastName":"li","suffix":""},{"id":260028901,"identity":"d19a5ae1-bcdf-438a-93c8-e71f81b88a88","order_by":2,"name":"xilin xu","email":"","orcid":"","institution":"Shanxi Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"xilin","middleName":"","lastName":"xu","suffix":""}],"badges":[],"createdAt":"2023-11-30 14:29:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3687439/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3687439/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":48486509,"identity":"24e1af96-8694-4f9e-81ed-b2bec1a34c28","added_by":"auto","created_at":"2023-12-19 19:50:01","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":137638,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart of patient selection\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3687439/v1/ab9a85ba4feca3a2e2dbf5c5.jpeg"},{"id":48486513,"identity":"44a47881-b181-4e2e-af81-ea0577214920","added_by":"auto","created_at":"2023-12-19 19:50:01","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":292723,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eABCD\u003c/strong\u003e Representative images of cases from the LBBAP and BIVP groups. \u003cstrong\u003eA, B\u003c/strong\u003e Final images of the leads of LBBAP at LAO 31°and RAO 28.7°, respectively; \u003cstrong\u003eC, D\u003c/strong\u003efinal images of leads of BIVP at LAO 28.6°and RAO 28.6°, respectively. LBB left bundle branch, LV left ventricular, RV right ventricular, RA right atrium.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3687439/v1/0bc78ed309bef6d1afd9691d.jpeg"},{"id":48486511,"identity":"49373fea-dd34-4a24-932e-827c863228a9","added_by":"auto","created_at":"2023-12-19 19:50:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":252012,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eABCD \u003c/strong\u003eLBBAP or BIVP corrected CLBBB or AVB in DCM patients. Twelve-lead ECG from LBBAP and BIVP are illustrated. \u003cstrong\u003eA\u003c/strong\u003e LBBAP shortened the QRS duration from 165 ms at baseline to 123 ms after 12 months of follow-up, while BIVP shortened the QRS duration from 168 ms to 151 ms. \u003cstrong\u003eB \u003c/strong\u003eChange of QRS on ECG after LBBAP or BIVP. \u003cstrong\u003eC \u003c/strong\u003eCompared with BIVP, LBBAP significantly decreased QRS duration.\u003c/p\u003e","description":"","filename":"F3.png","url":"https://assets-eu.researchsquare.com/files/rs-3687439/v1/bac0e31a00047bf847be02ab.png"},{"id":48487367,"identity":"55ce8f45-9f94-4b46-98f1-5dcf538bac0e","added_by":"auto","created_at":"2023-12-19 19:58:01","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":268407,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eABCD \u003c/strong\u003eEchocardiographic results at baseline and 12-month follow-up after LBBAP or BIVP.\u003cstrong\u003e ABC \u003c/strong\u003eLBBAP improved LAD, LVIDD and LVEF more significantly than BIVP.\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3687439/v1/c5ff8d8ac8344335ddb15afa.jpeg"},{"id":48486515,"identity":"e39e052e-78cf-4a86-b0d7-e4b6bdf2dba6","added_by":"auto","created_at":"2023-12-19 19:50:01","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":56115,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eABCDE \u003c/strong\u003eChanges in NYHA class after LBBAP or BIVP at baseline and 12 months follow-up.\u003cstrong\u003e AB \u003c/strong\u003eThe proportion of NYHA grade I and II in LBBAP group was significantly increased; \u003cstrong\u003eCD \u003c/strong\u003eThe proportion of NYHA Grade I and II in BIVP group was also significantly increased; \u003cstrong\u003eE \u003c/strong\u003eLBBAP was superior to BIVP in improving NYHA class.\u003c/p\u003e","description":"","filename":"F5.png","url":"https://assets-eu.researchsquare.com/files/rs-3687439/v1/45a06a65a7d2359f0dcd6917.png"},{"id":48486512,"identity":"08f54da8-1187-4899-8b7c-10750b083c17","added_by":"auto","created_at":"2023-12-19 19:50:01","extension":"jpeg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":109506,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAB \u003c/strong\u003eImprovement of cardiac function in patients with CLBBB. \u003cstrong\u003eA \u003c/strong\u003eThe duration of QRS in patients with complete correction of CLBBB was significantly lower than in patients with CLBBB correction failure and initial CLBBB in LBBAP group; \u003cstrong\u003eB \u003c/strong\u003eThe proportion of LVEF ≥ 45% in patients with QRSd ≤ 130 ms in LBBAP group was significantly higher than that in patients with QRSd\u0026gt;130 ms.\u003c/p\u003e","description":"","filename":"floatimage8.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3687439/v1/bdd65502814ff907ee47fe12.jpeg"},{"id":49583594,"identity":"ce54aca8-2d29-4444-b91c-7b5d1766a24e","added_by":"auto","created_at":"2024-01-14 11:52:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1165089,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3687439/v1/98d03632-7e3f-4a6e-98c4-1fcca9c3029e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of efficacy of left bundle branch area pacing and biventricular pacing in patients with dilated cardiomyopathy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDilated cardiomyopathy (DCM) is a primary myocardial disease with unknown causes, and its final stage is heart failure (HF). The degree of cardiac dyssynchrony is an independent predictor of sudden cardiac death and increased mortality in patients with heart failure\u003csup\u003e[1]\u003c/sup\u003e.Recent studies suggested that left bundle branch block(LBBB)-induced cardiomyopathy emerges as a distinct pathological entity\u003csup\u003e[2\u0026ndash;3]\u003c/sup\u003e. For patients with atrioventricular block(AVB), inappropriate pacing may induce cardiomyopathy\u003csup\u003e[4]\u003c/sup\u003e or increase the risk of heart failure(HF) admission\u003csup\u003e[5]\u003c/sup\u003e.In terms of current pacing methods, the procedure of biventricular pacing(BIVP) is complicated, especially for patients with tortuous vessels or coronary sinus ostium malformation. In addition, In addition, relevant studies have found that about 20\u0026ndash;40% of patients are not suitable for using BIVP\u003csup\u003e[6]\u003c/sup\u003e.His-Purkinje system pacing(HBP) is currently considered the optimal physio-logic pacing method \u003csup\u003e[7]\u003c/sup\u003e. However, high pacing threshold, low ventricular signal perception and technical difficulties can limit the application of HBP\u003csup\u003e[8]\u003c/sup\u003e.Intraseptal left bundle branch area pacing (LBBAP) is a novel technique to pace the conduction system beyond the site of block and is associated with low and stable capture thresholds \u003csup\u003e[9\u0026ndash;10]\u003c/sup\u003e. Recently LBBAP has been shown to restore left ventricle(LV) synchrony in patients with LBBB\u003csup\u003e[11]\u003c/sup\u003e. LBBAP has the potential advantage of backup LV septal capture in addition to left bundle branch (LBB) capture in these patients. In addition, LBBAP also showed significant advantage in improving cardiac function in patients with atrioventricular block with high ventricular pacing burden\u003csup\u003e[12]\u003c/sup\u003e. The aims of the study were to: 1) investigate the feasibility and safety of LBBAP in the treatment of DCM patients, and compare the clinical efficacy of LBBAP and BIVP, and 2) explore the different effects of LBBAP on DCM patients with CLBBB or atrioventricular block.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy patients\u003c/h2\u003e \u003cp\u003eThe hospitalized patients, diagnosed with DCM, were enrolled at the Shanxi Cardiovascular Disease Hospital from December 2018 to June 2022,and each patient received LBBAP or BIVP treatment. Inclusion criteria (One of them is enough) : Patients with symptomatic heart failure with sinus rhythm, QRS duration (QRSd)\u0026thinsp;\u0026gt;\u0026thinsp;130ms, LBBB or non LBBB, and LVEF\u0026thinsp;\u0026le;\u0026thinsp;35%; And optimized drug therapy for 3 months or more; 2. Sinus rhythm frequency\u0026thinsp;\u0026lt;\u0026thinsp;50 beats/minute, sinus arrest\u0026thinsp;\u0026gt;\u0026thinsp;3.0 seconds, or electrocardiogram showing second degree II, high degree, and third degree atrioventricular block, and symptoms caused by bradycardia, such as weakness, dizziness, dark outside, fainting, etc. The exclusion criteria were patients with valvular heart disease, coronary heart disease, congenital heart disease, or patients with a life expectancy of less than 1 year(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This study was approved by the Ethics Committee of Shanxi Cardiovascular Hospital.We confirm that all methods are carried out in accordance with relevant guidelines and regulations.Each patient signed the relevant informed consent form upon admission\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eDCM Dilated cardiomyopathy, HF Heart Failure, CLBBB Complete Left Bundle Branch Block, NYHA New York Heart Association, LBBAP Left Bundle Branch Area Pacing, BIVP Biventricular Pacing, LVEF Left Ventricular Ejection Fraction, LAD Left Atrial Dimension, LVIDD Left Ventricular Internal Diastolic Dimension.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eImplantation procedure\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eLeft bundle branch area pacing\u003c/h2\u003e \u003cp\u003eLBBAP was implemented using the 3830-pacing lead and C315 His sheath (Select Secure, 69 cm; C315 His sheath, Medtronic, Inc., Minneapolis, MN). LBBAP lead was initially placed in the typical his-bundle pacing area, as described in the HBP implantation method\u003csup\u003e[7,13]\u003c/sup\u003e.As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, under the right anterior oblique (RAO) perspective, the C315 sheath passes through the tricuspid annulus. Move the tip to the right ventricular septal area 1.5-2 cm away from the tricuspid annulus and output unipolar pacing. When the V1 QRS wave is W-shaped, it can serve as an ideal insertion point for the lead. In the left anterior oblique position (LAO), the pacemaker lead rotates to the interventricular septum, during which intermittent pacing is performed. When the QRS mode of the electrocardiogram is RBBB or similar to the normal QRS mode, and the QRS duration narrows, it is considered that the lead has reached the appropriate position. Finally, the pacing threshold and lead impedance were tested and the sheath was removed(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA, B).\u003c/p\u003e \u003cp\u003eThe criteria of the correction of CLBBB by LBBAP was characterized \u003csup\u003e[14]\u003c/sup\u003eby followings :(1) CLBBB morphology disappeared and a QR or rSR morphology in surface lead V1 was achieved. Paced QRS became narrow; (2) short average ventricular activation time (LVAT); 3) The position of lead tip was under the sub-endocardium of interventricular septum.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eBiventricular pacing\u003c/h2\u003e \u003cp\u003eBIVP was a technique for performing CRT. The lead tip in right ventricle was located at the apex of the right ventricle. According to the judgment of the operator, the right atrial lead was placed in the right atrial appendage or outside the right atrium. The left ventricular lead was placed on the posterolateral or lateral wall of LV with the help of coronary sinus angiography. The atrioventricular sequential pacing for BIVP was performed by equipment(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC, D).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData collection and follow-up\u003c/h2\u003e \u003cp\u003eBefore operation, baseline patient demographics, medical history, current medications, and electrocardiographic and echocardiographic findings were collected. LBB and BIV capture thresholds and pacing impedances were obtained at implantation and during device follow-up examinations. During the operation, we recorded procedure time and unipolar tip pacing thresholds and impedances of LBBAP or BIVP. Patients underwent regular follow-up at 1months,6months, and12months postimplantation in the hospital outpatient and device clinic, at the follow-up visit, ECG, capture threshold, and pacing impedance, were collected. Standard echocardiographic indices, including LVEF, LAD, and LVIDD, were acquired. We also documented NYHA class, and tracked complications and clinical outcomes, such as death and rehospitalization.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eValues are expressed as numbers and percentages for categorical variables and as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations (SDs) for continuous variables. Comparison categorical data was accomplished using the chi-squaredor Fisher's exact test, Comparisons of continuous variables were carried out using two-tailed Student\u0026rsquo;s t-or rank-sum tests. All statistical analyses were performed using SPSS soft-ware version 26.0, A p value of \u0026lt;\u0026thinsp;0.05 was considered to indicate statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eBaseline characteristics\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e,a total of 124 hospitalized patients with DCM were enrolled and followedupfor a mean duration of 11.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.88 months, of which 66 underwent LBBAP (mean 63.67\u0026thinsp;\u0026plusmn;\u0026thinsp;9.82 years, 71.21% males) while 58 received BIVP (mean 62.53\u0026thinsp;\u0026plusmn;\u0026thinsp;12.83 years, 77.59% males).63 patients underwent LBBAP as the first-line strategy. In 3 patients, LBBAP was used as a rescue attempt after failed coronary sinus lead placement. All patients had DCM at baseline, There were no significant differences between these two groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). All patients received optimized medical therapy including diuretic,β-blockers, angiotensin-converting enzyme inhibitor or angiotensin receptor antagonist, and aldosterone receptor antagonist. and were followed-up at 1-, 6-, and 12-month after pacing.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of patients who underwent LBBAP and BIVP\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLBBAP group (n\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBIVP group (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale, n %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (71.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (77.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.418\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63.67\u0026thinsp;\u0026plusmn;\u0026thinsp;9.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62.53\u0026thinsp;\u0026plusmn;\u0026thinsp;11.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical comorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension, n %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (50.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (41.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.337\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus, n %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (28.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (34.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.496\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal dysfunction, n %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (19.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (22.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.711\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtrial fibrillation, n %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (24.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (25.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.835\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehyperlipidemia, n %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (15.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (12.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.619\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCLBBB, n %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38(57.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32(55.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.788\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtrioventricular block, n %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (31.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (31.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.925\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQRSd, ms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e175.83\u0026thinsp;\u0026plusmn;\u0026thinsp;23.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e177.78\u0026thinsp;\u0026plusmn;\u0026thinsp;21.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.636\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEchocardiography parameters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.94\u0026thinsp;\u0026plusmn;\u0026thinsp;6.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.31\u0026thinsp;\u0026plusmn;\u0026thinsp;6.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAD, mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.12\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.84\u0026thinsp;\u0026plusmn;\u0026thinsp;4.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.783\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEDD, mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69.35\u0026thinsp;\u0026plusmn;\u0026thinsp;12.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.64\u0026thinsp;\u0026plusmn;\u0026thinsp;9.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNYHA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNYHA class II, n %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (22.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (18.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.608\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNYHA class III, n %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (56.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.565\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNYHA class IV, n %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (27.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (25.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.859\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNYHA class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.851\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrug therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiuretic, n %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (75.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47 (81.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.477\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACEI/ARB/ARNI, n %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (89.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (97.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.797\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeta-blocker, n %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (84.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52 (89.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.426\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAldosterone antagonist, n %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (84.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47(81.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.572\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eACEI angiotensin-converting enzyme inhibitor, ARB angiotensin II receptor blocker, ARNI angiotensin receptor-neprilysin inhibitor. Other abbreviations are as in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLBBAP and BIVP lead parameters\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, LBBAP resulted in significantly shorter procedural time (109.50\u0026thinsp;\u0026plusmn;\u0026thinsp;15.26 vs. 130.07\u0026thinsp;\u0026plusmn;\u0026thinsp;20.28 min, p༜ 0.001).Acute lead parameters including capture thresholds at pulse width of 0.5 ms, pacing impedances and R-wave amplitudes were 0.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20V、635.64\u0026thinsp;\u0026plusmn;\u0026thinsp;114.66Ωand8.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38mV.respectively. In addition, at implantation, the capture threshold of 3830 lead of LBBAP was lower than that of LV lead of BIVP, and these differences persisted at 1, 6, and 12 months of follow-up (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). However, we found no significant differences in pacing impedance between the LBBAP and BIVP groups at implantation or follow-up (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). During follow-up, both LBBAP and BIVP showed a slight decrease in capture threshold and pacing impedance, but still remained stable. Echocardiography showed that the pacing lead was positioned at the sub-endocardium of Interventricular septum in all patients. No perforation into LV cavity or pericardial effusion was observed.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePacing parameters of patients in the LBBAP and BIVP groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcedural characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLBBAP group (n\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBIVP group (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePacing types, n%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRT-P\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32(48.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(34.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRT-D\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(51.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37(65.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e168\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcedural time, min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109.50\u0026thinsp;\u0026plusmn;\u0026thinsp;15.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e130.07\u0026thinsp;\u0026plusmn;\u0026thinsp;20.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-wave amplitude, mV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePacing parameters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLV or 3830 lead impedance, Ω\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt implant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e635.64\u0026thinsp;\u0026plusmn;\u0026thinsp;114.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e662.02\u0026thinsp;\u0026plusmn;\u0026thinsp;116.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-month follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e640.60\u0026thinsp;\u0026plusmn;\u0026thinsp;119.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e659.43\u0026thinsp;\u0026plusmn;\u0026thinsp;113.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.381\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-month follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e631.78\u0026thinsp;\u0026plusmn;\u0026thinsp;116.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e664.17\u0026thinsp;\u0026plusmn;\u0026thinsp;123.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12-month follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e637.42\u0026thinsp;\u0026plusmn;\u0026thinsp;113.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e662.96\u0026thinsp;\u0026plusmn;\u0026thinsp;113.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.234\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLV or 3830 lead thresholds, at 0.5 ms, V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt implant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-month follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-month follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12-month follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eChanges in QRS duration\u003c/h2\u003e \u003cp\u003eOverall, the baseline and follow-up QRSd data of LBBAP group and BIVP group showed that the QRSd of 12-lead ECG in both groups was significantly reduced (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA).Specifically, the duration of QRS in LBBAP group significantly decreased from a baseline 175.83\u0026thinsp;\u0026plusmn;\u0026thinsp;23.86 ms to 128.18\u0026thinsp;\u0026plusmn;\u0026thinsp;12.95 ms(p\u0026thinsp;\u0026lt;\u0026thinsp;0.001),and the QRSd of 58 patients in the BIVP group decreased from baseline 177.78\u0026thinsp;\u0026plusmn;\u0026thinsp;21.49 to 153.53\u0026thinsp;\u0026plusmn;\u0026thinsp;13.43ms(p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)(Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB).Although QRS duration decreased in patients with LBBAP and BIVP compared with baseline, this reduction was greater in patients with LBBAP (47.65\u0026thinsp;\u0026plusmn;\u0026thinsp;17.94 vs24.41\u0026thinsp;\u0026plusmn;\u0026thinsp;15.80 ms,p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 )\u003c/p\u003e \u003cp\u003e(Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eChanges in echocardiographic measurements(simpson measurement method)\u003c/h2\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e,patients in both groups exhibited significantly improved LAD, LVIDD, and LVEF in both LBBAP and BIVP from baseline to follow-up of 12-month.In LBBAP group, LAD decreased from 47.12\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35mm to 39.02\u0026thinsp;\u0026plusmn;\u0026thinsp;4.64mm (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), LV ID D decreased from 69.35\u0026thinsp;\u0026plusmn;\u0026thinsp;12.05mm to 57.98\u0026thinsp;\u0026plusmn;\u0026thinsp;9.26mm (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and LVEF increased from27.94\u0026thinsp;\u0026plusmn;\u0026thinsp;6.82% to 44.55\u0026thinsp;\u0026plusmn;\u0026thinsp;6.46% during 12-month follow-up (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Figure.4ABC).In BIVP group, LAD decreased from 46.84\u0026thinsp;\u0026plusmn;\u0026thinsp;4.77mm to 42.98\u0026thinsp;\u0026plusmn;\u0026thinsp;5.84mm (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), LVIDD decreased from 68.64\u0026thinsp;\u0026plusmn;\u0026thinsp;9.86mm to 62.09\u0026thinsp;\u0026plusmn;\u0026thinsp;7.75mm (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and LVEF increased from 28.31\u0026thinsp;\u0026plusmn;\u0026thinsp;6.58% to 37.30\u0026thinsp;\u0026plusmn;\u0026thinsp;5.67% (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) after 12-month follow up (Figure.4ABC). In addition, 7 out of 66 patients in the LBBAP group and 2 out of 58 patients in BIVP group exhibited super-response(LVEF༞50%), although the super-response rate did not significantly differ between LBBAP and BIVP group (10.61% vs. 3.45%,p\u0026thinsp;=\u0026thinsp;0.172).The improvement of LVEF was greater in the LBBAP group than that in the BIVP group (16.68\u0026thinsp;\u0026plusmn;\u0026thinsp;8.27% vs 8.94\u0026thinsp;\u0026plusmn;\u0026thinsp;6.39%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The improvement in other echocardiographic parameters such as LAD (8.12\u0026thinsp;\u0026plusmn;\u0026thinsp;6.78mm vs. 3.89\u0026thinsp;\u0026plusmn;\u0026thinsp;5.45mm, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and LVIDD (11.30\u0026thinsp;\u0026plusmn;\u0026thinsp;7.24mm vs. 6.61\u0026thinsp;\u0026plusmn;\u0026thinsp;5.54mm, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001)were similar to the changes in LVEF.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eChanges in clinical cardiac function\u003c/h2\u003e \u003cp\u003eAs shown in Figure\u0026ensp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e,NYHA classification significantly decreased in both groups. In LBBAP group, the percentage of patients with NYHA grade I increased from 0 to 39.4%, and the percentage of grade II increased from 22.7\u0026ndash;36.4%. LBBAP decreased NYHA class at the 12-month follow-up compared with baseline (3.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u0026thinsp;~\u0026thinsp;1.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91,p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In BIVP group, the percentage of patients with NYHA grade I increased from 0 to 6.9%, and the percentage of grade II increased from 19.0\u0026ndash;53.45%. BIVP decreased NYHA class at the 12-month follow-up compared with baseline (3.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u0026thinsp;~\u0026thinsp;2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60, p༜0.001).Overall, NYHA classification significantly decreased in both groups, and the percentage of patients in NYHA classification grade I and II was significantly higher in the LBBAP group compared to that in the BIVP group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eAssociation of CLBBB correction and improved cardiac function\u003c/h2\u003e \u003cp\u003eAs shown in Table\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ensp;,there were 38 patients with CLBBB in the LBBAP group and 32 in the BIVP group. In the LBBAP group, complete correction of the LBBB (QRSd\u0026thinsp;\u0026le;\u0026thinsp;130 ms) was achieved in 16 patients. However, in the BIVP group, only 1 patient achieved QRSd\u0026thinsp;\u0026le;\u0026thinsp;130ms.Obviously, the proportion of patients with CLBBB whose QRSd rhythm\u0026thinsp;\u0026le;\u0026thinsp;130 ms was significantly higher in the LBBAP group than in the BIVP group (16/38 vs 1/32, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).In conclusion, the effective rate of LBBAP in the complete correction of CLBBB is much higher than that of BIVP. We further compared the duration of QRS in patients with CLBBB correction in the LBBAP group with those with CLBBB failure. We found that the duration of QRS in patients with complete correction of CLBBB was lower than that in patients with CLBBB failure (116.06\u0026thinsp;\u0026plusmn;\u0026thinsp;13.14 vs. 138.82\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50 ms, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).They are both much smaller than the initial QRSd of CLBBB correction(175.83\u0026thinsp;\u0026plusmn;\u0026thinsp;23.86 ms)༈Figure\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eA\u003cb\u003e༉\u003c/b\u003e.This still indicated that the effectiveness of LBBAP in the treatment of patients with DCM with CLBBB. In addition, Subgroup analysis found that the proportion of LVEF\u0026thinsp;\u0026ge;\u0026thinsp;45% in patients with QRSd\u0026thinsp;\u0026le;\u0026thinsp;130 ms in LBBAP group was significantly higher than that in patients with QRSd\u0026thinsp;\u0026gt;\u0026thinsp;130 ms (QRSd\u0026thinsp;\u0026gt;\u0026thinsp;130 ms) (25/38 vs 9/28, p\u0026thinsp;=\u0026thinsp;0.007)༈Figure\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eB\u003cb\u003e༉\u003c/b\u003e.The subgroup analysis suggested that the improvement of LVEF was correlated with the complete correction of CLBBB. However, no such phenomenon was found in LAD and LVIDD.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eAtrioventricular block correction is associated with improved cardiac function\u003c/h2\u003e \u003cp\u003eAs shown in Table\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ensp;,there were 21 patients with atrioventricular block in the LBBAP group and 18 in the BIVP group. In the LBBAP group, correction of the atrioventricular block\u003c/p\u003e \u003cp\u003e(QRSd\u0026thinsp;\u0026le;\u0026thinsp;130 ms) was achieved in 14 patients. However, in the BIVP group, only 1 patient achieved QRSd\u0026thinsp;\u0026le;\u0026thinsp;130ms.Obviously, the proportion of patients with atrioventricular block whose QRSd rhythm\u0026thinsp;\u0026le;\u0026thinsp;130 ms was significantly higher in the LBBAP group than in the BIVP group (14/21 vs 1/18, p༜0.001).In conclusion, the effective rate of LBBAP in the correction of atrioventricular block is much higher than that of BIVP. Both LBBAP and BIVP shortened 12-lead ECG QRSd in patients with DCM complicated with atrioventricular block, but the QRSd of LBBAP group were significantly narrower than those of BIVP group(126.81\u0026thinsp;\u0026plusmn;\u0026thinsp;11.32 vs 153.72\u0026thinsp;\u0026plusmn;\u0026thinsp;17.77 ms, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) .Additionally, Analysis of different follow-up periods showed that 8 patients with atrioventricular block correction exhibited higher LVEF(47.21\u0026thinsp;\u0026plusmn;\u0026thinsp;5.52 vs. 35.08\u0026thinsp;\u0026plusmn;\u0026thinsp;8.53%, p༜0.001), lower LAD(38.21\u0026thinsp;\u0026plusmn;\u0026thinsp;4.39vs. 45.25\u0026thinsp;\u0026plusmn;\u0026thinsp;8.73 mm, p\u0026thinsp;=\u0026thinsp;0.021), and lower LVIDD(54.50\u0026thinsp;\u0026plusmn;\u0026thinsp;6.48vs. 63.42\u0026thinsp;\u0026plusmn;\u0026thinsp;12.43 mm, p\u0026thinsp;=\u0026thinsp;0.028) compared to the 5 patients with atrioventricular block at 12-month follow-up .These results further demonstrated that atrioventricular block correction was associated with improved cardiac function.\u003c/p\u003e \u003cp\u003eTo sum up, we found that LBBAP is better than BIVP in CLBBB and AVB patients. Further investigating the difference of curative effect between CLBBB patients and AVB patients, it was found that there was no statistically significant difference in the improvement of LVEF, LAD and cardiac function grading between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05),but the improvement of LVIDD(13.45\u0026thinsp;\u0026plusmn;\u0026thinsp;5.89mm vs. 9.33\u0026thinsp;\u0026plusmn;\u0026thinsp;8.22mm p\u0026thinsp;=\u0026thinsp;0.030)and QRSd(51.26\u0026thinsp;\u0026plusmn;\u0026thinsp;16.69 vs 42.29\u0026thinsp;\u0026plusmn;\u0026thinsp;12.26 ms, p\u0026thinsp;=\u0026thinsp;0.035) in CLBBB patients was significantly higher than that in AVB patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eClinical outcomes\u003c/h2\u003e \u003cp\u003eDuring the 12-month follow up period, we tracked complications and clinical outcomes, such as death and re-hospitalization. Two patients in the LBBAP group ware readmitted to the hospital with HF, and one patient was readmitted for pacemaker lead adjustment. In the BIVP group, four patients were readmitted because of worsening HF and one patient died. Among the 4 readmission patients, 1 patient was readmitted 2 times, 1 patient was readmitted 3 times, and 1 patient was readmitted 5 times. This indicated that the number of hospitalizations in the LBBAP group was significantly lower than that in the BIVP group (p\u0026thinsp;=\u0026thinsp;0.004),which suggested that the rate of rehospitalization in the LBBAP group was significantly lower than that in the BIVP group.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe main findings of this retrospective, observational study are as follows:1. This study demonstrated the feasibility and safety of LBBAP in the treatment of patients with DCM, and was associated with few adverse outcomes;2.Both LBBAP and BIVP can improve the QRSd, LVEF,LAD,LVIDD, NYHA class and other cardiac function indexes in patients with DCM, and the degree of improvement of LBBAP is more obvious than that of BIVP;3.Compared with BIVP, LBBAP can successfully correct CLBBB and AVB, and is feasible as an alternative to CRT;4.QRSd can be used as independent predictors of cardiac function and clinical adverse reactions in patients with DCM.\u003c/p\u003e \u003cp\u003eMany studies\u003csup\u003e[15\u0026ndash;19]\u003c/sup\u003e and our study have shown that LBBAP was safe and feasible. Our study and many studies\u003csup\u003e[16,20\u0026ndash;23]]\u003c/sup\u003ehave further demonstrated that LBBAP was associated with few adverse outcomes or very mild complications, and the rehospitalization rate was significantly lower than that of BIVP group. Previous studies\u003csup\u003e[14,21]\u003c/sup\u003e have shown that LBBAP can significantly shorten QRSd. In our study, both LBBAP and BIVP can significantly reduce QRSd, and the degree of LBBAP reducing QRSd was particularly significant. The decrease of cardiac function and the occurrence of clinical adverse reactions may be related to the enlargement of the heart cavity,this can also be seen in the study of Adhyapak\u003csup\u003e[24]\u003c/sup\u003e. For example, when left ventricular dilation increases significantly, LVEF decreases, pulmonary artery systolic blood pressure (PASP) and greater diatolic dysfunction increase, and the number of readmissions and deaths also increases significantly. Previous study have found that there was a strong correlation between the prolongation of the peak time of left ventricular pressure rise and cardiac dyssynchrony before ejection\u003csup\u003e[25]\u003c/sup\u003e, and the decline of cardiac function may be related to ventricular electrical asynchrony. From our research, we can see that LBBAP has a more obvious role in reverse remodeling of cardiac structure than BIVP and can significantly reduce LAD and LVIDD. Therefore, the advantages of LBBAP may be related to its ability to provide more physiological ventricular activation modes, generate better electrical and mechanical resynchronization\u003csup\u003e[26\u0026ndash;29]\u003c/sup\u003e, and may have beneficial effects on left atrial function by reducing LAD in patients with high ventricular pacing load. In contrast, the left ventricular electrode of BIVP reaches the epicardium of the left ventricle through the target vein. The cardiac excitation is from the epicardium to the endocardium, and non-physiological pacing is carried out in the left and right ventricles, thus prolonging the left ventricular activation time\u003csup\u003e[30\u0026ndash;31]\u003c/sup\u003e. In general, LBBAP is superior to BIVP in improving electrocardiogram and echocardiography results.\u003c/p\u003e \u003cp\u003eWe try to find out the different effects of LBBAP in different patients. Specifically, it is the different effects of LBBAP on patients with cardiac insufficiency and left bundle branch block or atrioventricular block. In our study, 65.79% of CLBBB patients in the LBBAP group achieved complete correction (QRSd\u0026thinsp;\u0026lt;\u0026thinsp;130ms), which is lower than the success rate of complete correction of CLBBB by LBBAP in previous studies\u003csup\u003e[9,32]\u003c/sup\u003e, which may be related to the complications of patients and the experience of operators. The report of Upadhyay GA\u003csup\u003e[33]\u003c/sup\u003esuggested that some types of LBBB cannot be corrected with His-Purkinje system pacing, such as left ventricular slow conduction caused by myocardial injury, and conduction disorder caused by scar or distal branch of left bundle branch\u003csup\u003e[34]\u003c/sup\u003e. Researches in recent years suggested that\u003csup\u003e[9,35]\u003c/sup\u003eLBBAP was a safe and effective resynchronization method for patients with cardiac insufficiency and electrical asynchrony, which can achieve the same clinical effect as CRT. Our research results demonstrated that the improvement of cardiac function is related to the correction of CLBBB and AVB.From this study, it can be seen that LBBAP significantly improves QRSd and LVIDD in CLBBB patients compared to AVB patients. LBBAP has a more significant improvement effect on CLBBB patients than AVB patients.\u003c/p\u003e \u003cp\u003eLBBAP, as a novel physiological pacing mode, can directly pace the final pathway of the cardiac electrical conduction pathway across the blocked part. It can be the first choice for patients with cardiac electrical conduction pathway block, and can also be a candidate for patients with difficulty in implanting left ventricular leads or no response after implantation during BIVP surgery.\u003c/p\u003e \u003cp\u003eSome articles\u003csup\u003e[14,21]\u003c/sup\u003e and our research have reached the same conclusion: LBBAP is a cardiac synchronization therapy method that can replace BIVP. The characteristics of our study are as follows: (1) This study focused on the treatment of LBBAP in patients with DCM, and compared the efficacy of LBBAP and BIVP; (2) We found that patients with successful correction of CLBBB and AVB achieved better clinical efficacy, and QRSD could be used as independent predictors of cardiac function and clinical adverse reactions in patients with DCM; (3) In a subgroup analysis of patients with DCM with CLBBB or AVB, we found that LBBAP improved left ventricular structure and QRSd significantly better in patients with CLBBB than in patients with AVB. However, our research needs more sample size and longer follow-up time to verify.\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and risks\u003c/h2\u003e \u003cp\u003eThere are some limitations in this study. Firstly, the follow-up time is relatively short, and there is a lack of BNP, fluoroscopy time, hemodynamic monitoring, and other data. Secondly, although the total number of cases has reached a certain number, the number of cases during subgroup analysis is very small, and the conclusions drawn still need more research to verify. Of course, there are also some safety issues with LBBAP itself, such as the risk of thrombosis when acute and late perforation of the left ventricle occurs deep in the septum, and the lead tip is exposed to the left ventricle for a long time. Although Zhong's research\u003csup\u003e[36]\u003c/sup\u003eindicated that the occurrence of acute ventricular septal perforation could be reduced by determining the time to stop tightening the lead by the peak value of the R wave in the V5 lead, other risks remained unsolved. In addition, the existing literature has not been studied for a long time and cannot obtain long-term efficacy results.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eTo sum up, LBBAP is feasible and safe for the treatment of patients with dilated cardiomyopathy and is only associated with few adverse outcomes or very slight complications. LBBAP has more obvious effect on improving ventricular electrical synchronization, cardiac function and clinical response than BIVP, and can promote LA and LV reverse remodeling. LBBAP can be used as the first choice for patients with cardiac electrical conduction pathway block, and also as an alternative for patients with difficulty in implanting left ventricular electrode during BIVP or no response after implantation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudy concept and design: Qiang He\u0026nbsp;and Xiaoming Li.\u0026nbsp;Analysis and interpretation of data: Qiang He, Xiaoming Li, Xilin Xu.\u0026nbsp;Drafting of the manuscript: Qiang He and Xiaoming Li.\u0026nbsp;Critical revision of the manuscript for important intellectual content: Qiang He, Xiaoming Li and Xilin Xu.\u0026nbsp;Statistical analysis: Qiang He.\u0026nbsp;Approval of the article: Qiang He, Xiaoming Li, Xilin Xu.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGMENTS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThanks to the Shanxi Cardiovascular Hospital,Chengdu BOE Hospital and the Graduate School of Shanxi Medical University for technical support of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONFLICT OF INTEREST\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDATA AVAILABILITY STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePrinz C, Lehmann R, Schwarz M, et al. - Left ventricular dyssynchrony predicts clinical response to CRT - a long-term follow-up single-center prospective observational cohort study[J]. Echocardiography, 2013, 30(8): 896\u0026ndash;903.\u003c/li\u003e\n\u003cli\u003eSanna GD, De Bellis A, Zecchin M, et al. - Prevalence, clinical and instrumental features of left bundle branch block-induced cardiomyopathy: the CLIMB registry[J]. ESC Heart Fail, 2021, 8(6): 5589-93.\u003c/li\u003e\n\u003cli\u003eSanna GD, Merlo M, Moccia E, et al. - Left bundle branch block-induced cardiomyopathy: a diagnostic proposal for a poorly explored pathological entity[J]. Int J Cardiol, 2020, 299: 199\u0026ndash;205.\u003c/li\u003e\n\u003cli\u003eKiehl EL, Makki T, Kumar R, et al. - Incidence and predictors of right ventricular pacing-induced cardiomyopathy in patients with complete atrioventricular block and preserved left ventricular systolic function[J]. Heart Rhythm, 2016, 13(12): 2272-8.\u003c/li\u003e\n\u003cli\u003eMittal S, Musat DL, Hoskins MH, et al. - Increased healthcare utilization associated with complete atrioventricular block in pacemaker patients[J]. J Interv Card Electrophysiol, 2018, 51(3): 221-8.\u003c/li\u003e\n\u003cli\u003eBoogers MM, Van Kriekinge SD, Henneman MM, et al. - Quantitative gated SPECT-derived phase analysis on gated myocardial perfusion SPECT detects left ventricular dyssynchrony and predicts response to cardiac resynchronization therapy[J]. J Nucl Med, 2009, 50(5): 718\u0026thinsp;\u0026minus;\u0026thinsp;25.\u003c/li\u003e\n\u003cli\u003eHuang W, Su L, Wu S, et al. - Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block[J]. Heart, 2019, 105(2): 137\u0026thinsp;\u0026minus;\u0026thinsp;43.\u003c/li\u003e\n\u003cli\u003eSubzposh FA, Vijayaraman P. - Long-Term Results of His Bundle Pacing[J]. Card Electrophysiol Clin, 2018, 10(3): 537\u0026thinsp;\u0026minus;\u0026thinsp;42.\u003c/li\u003e\n\u003cli\u003eVijayaraman P, Subzposh FA, Naperkowski A, et al. - Prospective evaluation of feasibility and electrophysiologic and echocardiographic characteristics of left bundle branch area pacing[J]. Heart Rhythm, 2019, 16(12): 1774-82.\u003c/li\u003e\n\u003cli\u003eZhang S, Zhou X, Gold MR. - Left Bundle Branch Pacing: JACC Review Topic of the Week[J]. J Am Coll Cardiol, 2019, 74(24): 3039-49.\u003c/li\u003e\n\u003cli\u003eHou X, Qian Z, Wang Y, et al. - Feasibility and cardiac synchrony of permanent left bundle branch pacing through the interventricular septum[J]. Europace, 2019, 21(11): 1694\u0026thinsp;\u0026minus;\u0026thinsp;702.\u003c/li\u003e\n\u003cli\u003eLi X, Zhang J, Qiu C, et al. - Clinical Outcomes in Patients With Left Bundle Branch Area Pacing vs. Right Ventricular Pacing for Atrioventricular Block[J]. Front Cardiovasc Med, 2021, 8(685253): 685253.\u003c/li\u003e\n\u003cli\u003eVijayaraman P, Dandamudi G. - How to Perform Permanent His Bundle Pacing: Tips and Tricks[J]. Pacing Clin Electrophysiol, 2016, 39(12): 1298\u0026thinsp;\u0026minus;\u0026thinsp;304.\u003c/li\u003e\n\u003cli\u003eWang Y, Gu K, Qian Z, et al. - The efficacy of left bundle branch area pacing compared with biventricular pacing in patients with heart failure: A matched case-control study[J]. J Cardiovasc Electrophysiol, 2020, 31(8): 2068-77.\u003c/li\u003e\n\u003cli\u003eChen K, Li Y, Dai Y, et al. - Comparison of electrocardiogram characteristics and pacing parameters between left bundle branch pacing and right ventricular pacing in patients receiving pacemaker therapy[J]. Europace, 2019, 21(4): 673\u0026thinsp;\u0026minus;\u0026thinsp;80.\u003c/li\u003e\n\u003cli\u003eLi X, Li H, Ma W, et al. - Permanent left bundle branch area pacing for atrioventricular block: Feasibility, safety, and acute effect[J]. Heart Rhythm, 2019, 16(12): 1766-73.\u003c/li\u003e\n\u003cli\u003eChen Z, Zhou X, Ma X, et al. - Recruitment of the cardiac conduction system for optimal resynchronization therapy in failing heart[J]. Front Physiol, 2022, 13(1045740): 1045740.\u003c/li\u003e\n\u003cli\u003eJiang Z, Chen Y, Chen C, et al. - Feasibility and safety of left bundle branch area pacing in very elderly patients (\u0026ge;\u0026thinsp;80 years)[J]. Kardiol Pol, 2022, 80(4): 452\u0026thinsp;\u0026minus;\u0026thinsp;60.\u003c/li\u003e\n\u003cli\u003eHeckman LIB, Luermans JGLM, Jastrzębski M, et al. - A single-centre prospective evaluation of left bundle branch area pacemaker implantation characteristics[J]. Neth Heart J, 2022, 30(5): 249\u0026thinsp;\u0026minus;\u0026thinsp;57.\u003c/li\u003e\n\u003cli\u003eJastrzębski M, Kiełbasa G, Cano O, et al. - Left bundle branch area pacing outcomes: the multicentre European MELOS study[J]. Eur Heart J, 2022, 43(40): 4161-73.\u003c/li\u003e\n\u003cli\u003eHua J, Chen Y, Yu J, et al. - Long-term outcomes of left bundle branch area pacing versus biventricular pacing in patients with heart failure and complete left bundle branch block[J]. Heart Vessels, 2022, 37(7): 1162-74.\u003c/li\u003e\n\u003cli\u003eLiu X, Li W, Zeng J, et al. - Evaluation of clinical safety and efficacy of left bundle branch area pacing in comparison with right ventricular septal pacing[J]. Medicine, 2022, 101(11).\u003c/li\u003e\n\u003cli\u003eSharma PS, Patel NR, Ravi V, et al. - Clinical outcomes of left bundle branch area pacing compared to right ventricular pacing: Results from the Geisinger-Rush Conduction System Pacing Registry[J]. Heart Rhythm, 2022, 19(1): 3\u0026ndash;11.\u003c/li\u003e\n\u003cli\u003eAdhyapak SM, Thomas T, Jose MT, et al. - Effect of left ventricular geometric remodeling on restrictive filling pattern and survival in ischemic cardiomyopathy[J]. Indian Heart J, 2022, 74(3): 206\u0026thinsp;\u0026minus;\u0026thinsp;11.\u003c/li\u003e\n\u003cli\u003eOdland HH, Villegas-Martinez M, Ross S, et al. - Shortening of time-to-peak left ventricular pressure rise (Td) in cardiac resynchronization therapy[J]. ESC Heart Fail, 2021, 8(6): 5222-36.\u003c/li\u003e\n\u003cli\u003eZhang W, Chen L, Zhou X, et al. - Resynchronization effects and clinical outcomes during left bundle branch area pacing with and without conduction system capture[J]. Clin Cardiol, 2023, 3(10): 23969.\u003c/li\u003e\n\u003cli\u003eZhu H, Wang Z, Li X, et al. - Medium- and Long-Term Lead Stability and Echocardiographic Outcomes of Left Bundle Branch Area Pacing Compared to Right Ventricular Pacing[J]. J Cardiovasc Dev Dis, 2021, 8(12).\u003c/li\u003e\n\u003cli\u003eMei Y, Han R, Cheng L, et al. - Assessment of Cardiac Function and Ventricular Mechanical Synchronization in Left Bundle Branch Area Pacing by Speckle Tracking and Three-Dimensional Echocardiography[J]. Am J Cardiol, 2023, 187: 1\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eWang S, Lan R, Zhang N, et al. - LBBAP in patients with normal intrinsic QRS duration: Electrical and mechanical characteristics[J]. Pacing Clin Electrophysiol, 2021, 44(1): 82\u0026ndash;92.\u003c/li\u003e\n\u003cli\u003eCurtis AB, Worley SJ, Adamson PB, et al. - Biventricular pacing for atrioventricular block and systolic dysfunction[J]. N Engl J Med, 2013, 368(17): 1585-93.\u003c/li\u003e\n\u003cli\u003ePloux S, Whinnett Z, Lumens J, et al. - Acute hemodynamic response to biventricular pacing in heart failure patients with narrow, moderately, and severely prolonged QRS duration[J]. Heart Rhythm, 2012, 9(8): 1247-50.\u003c/li\u003e\n\u003cli\u003eHuang W, Wu S, Vijayaraman P, et al. - Cardiac Resynchronization Therapy in Patients With Nonischemic Cardiomyopathy Using Left Bundle Branch Pacing[J]. JACC Clin Electrophysiol, 2020, 6(7): 849\u0026thinsp;\u0026minus;\u0026thinsp;58.\u003c/li\u003e\n\u003cli\u003eUpadhyay GA, Cherian T, Shatz DY, et al. - Intracardiac Delineation of Septal Conduction in Left Bundle-Branch Block Patterns[J]. Circulation, 2019, 139(16): 1876-88.\u003c/li\u003e\n\u003cli\u003eLi X, Fan X, Li H, et al. - ECG patterns of successful permanent left bundle branch area pacing in bradycardia patients with typical bundle branch block[J]. Pacing Clin Electrophysiol, 2020, 43(8): 781\u0026thinsp;\u0026minus;\u0026thinsp;90.\u003c/li\u003e\n\u003cli\u003eZu L, Wang Z, Hang F, et al. - Cardiac resynchronization performed by LBBaP-CRT in patients with cardiac insufficiency and left bundle branch block[J]. Ann Noninvasive Electrocardiol, 2021, 26(6): 12898.\u003c/li\u003e\n\u003cli\u003eZhong J, Zheng N, Jiang L. - Evaluation of the shortening of the stimulus-to-peak left ventricular activation time at continuous low output to confirm left bundle branch capture[J]. Heart Rhythm O2, 2022, 3(4): 351-7.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cardiac resynchronization therapy, dilated cardiomyopathy, left bundle branch area pacing, biventricular pacing, complete left bundle branch block, Atrioventricular block.","lastPublishedDoi":"10.21203/rs.3.rs-3687439/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3687439/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eLeft bundle branch area pacing (LBBAP) is a type of conduction system pacing (CSP), and is often used as an alternative to traditional biventricular pacing (BIVP).For patients with dilated cardiomyopathy, there is still a lack of comparison between the efficacy of LBBAP and BIVP, and the different efficacy of LBBAP in patients with left bundle branch block(LBBB) or atrioventricular block(AVB).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e124 patients with dilated cardiomyopathy were retrospectively collected and divided into LBBAP group (n\u0026thinsp;=\u0026thinsp;66) and BIVP group (n\u0026thinsp;=\u0026thinsp;58) according to different surgical methods. Preoperative electrocardiogram (ECG), echocardiogram, clinical cardiac function grading, intraoperative implantation parameters, and follow-up results at 1, 6, and 12 months after pacemaker implantation of all patients were collected. The two groups of data were compared and subgroup analysis was conducted to explore the different therapeutic effects of LBBAP on patients with CLBBB and patients with AVB respectively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eCompared with BIVP, LBBAP produces lower and stable pacing threshold and shorter operation time. LBBAP reduced QRSd significantly more than BIVP (47.65\u0026thinsp;\u0026plusmn;\u0026thinsp;17.94 vs 24.41\u0026thinsp;\u0026plusmn;\u0026thinsp;15.80 ms, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). It should be emphasized that LBBAP and BIVP improved left ventricular ejection fraction(LVEF), left atrial diameter(LAD), left ventricular internal diameter at end-diastole(LVIDD) and New York Heart Association(NYHA) class of patients with dilated cardiomyopathy compared with baseline, but LBBAP improved more significantly than BIVP. In addition, the number of readmissions of patients receiving LBBAP was significantly lower than that of BIVP group (p\u0026thinsp;=\u0026thinsp;0.004). Subgroup analysis showed that the improvement of cardiac function was related to the correction of electrical conduction asynchrony; In the LBBAP group, the improvement of LVIDD in CLBBB patients was significantly higher than that in AVB patients (11.30\u0026thinsp;\u0026plusmn;\u0026thinsp;7.24mm vs. 6.61\u0026thinsp;\u0026plusmn;\u0026thinsp;5.54 mm).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eCompared with BIVP, LBBAP can better optimize electrical synchronization and improve cardiac function and clinical outcome and can be the first choice for patients with cardiac conduction pathway block. LBBAP has a better effect on improving left ventricular structure in patients with CLBBB than in patients with AVB.\u003c/p\u003e","manuscriptTitle":"Comparison of efficacy of left bundle branch area pacing and biventricular pacing in patients with dilated cardiomyopathy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-12-19 19:49:56","doi":"10.21203/rs.3.rs-3687439/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4fbf7d13-dcc2-4115-96b4-7b38cf5142ef","owner":[],"postedDate":"December 19th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":27463780,"name":"Health sciences/Cardiology"},{"id":27463781,"name":"Health sciences/Diseases"},{"id":27463782,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2024-01-14T11:44:15+00:00","versionOfRecord":[],"versionCreatedAt":"2023-12-19 19:49:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3687439","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3687439","identity":"rs-3687439","version":["v1"]},"buildId":"omnImTCwR2MFx8CMYfrG7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}