Article Impact Level: HIGH Data Quality: STRONG Summary of JACC: Clinical Electrophysiology, 8(11), 1431–1445. https://doi.org/10.1016/j.jacep.2022.08.001 Dr. Margarida Pujol-Lopez et al
Points
- The LEVEL-AT study demonstrated that, across patient populations, ventricular synchronization obtained with conduction system pacing is non-inferior to customary biventricular pacing.
- His-pack pacing was a piece of the conduction framework pacing, although left-group branch block pacing was the principal strategy.
- Clinical experiments will be required to examine this strategy because it seems intriguing.
Summary
The experiment’s objective was to determine if biventricular pacing would be non-inferior to conduction system pacing.
The number of participants who got screened was 80, and those who underwent a randomized ratio were 70. The inclusion criteria for the trial were individuals over the age of 18. Patients who faced severe cardiovascular disorders and received adequate medical care but showed a left ventricular ejection fraction rate below 35% were also selected to participate. Individuals with vast QRS complexes were also selected as candidates for the trial. Of those individuals with permanent atrial fibrillation, about 8% were part of the trial. However, participants with myocardial infarction, unstable angina, or cardiovascular revascularization in the past 90 days were removed from the trial.
Conduction system pacing, or biventricular pacing, was randomly assigned to participants in equal ratios. Each group had 35 participants, and biventricular pacing devices were implanted according to standard procedure. The anterolateral positioning of the left ventricle lead was recommended. The conduction system lead was adjusted at the His-Purkinje system at the start. After the first month of the trial, the protocol was changed to permit the operator to choose either of the two techniques, either bundle pacing or left bundle branch pacing.
Only 4 of the participants assigned to conduction system pacing got His Bundle Pacing, whereas 20% of respondents assigned to conduction system pacing followed His pacing, with a 57% implantation success rate. Similarly, left bundle branch pacing was continued in 28 participants out of 35, with an implantation success rate of 82%. There were 8 transitions between biventricular pacing and conduction system pacing overall.
Conduction system pacing vs. biventricular pacing had the main result of a shift in left ventricular mobilization time from the start on electrocardiographic imaging in ratios 28 and 21, respectively. The secondary results of the trial were a shift in QRS complex values from 53 to 48 and a heart failure mortality ratio from 1 to 4 percent in the respective groups.
Link to the article: https://www.jacc.org/doi/10.1016/j.jacep.2022.08.001
References Pujol-Lopez, M., Jiménez-Arjona, R., Garre, P., Guasch, E., Borràs, R., Doltra, A., Ferró, E., García-Ribas, C., Niebla, M., Carro, E., Puente, J. L., Vázquez-Calvo, S., Invers-Rubio, E., Roca-Luque, I., Castel, M. Á., Arbelo, E., Sitges, M., Brugada, J., Tolosana, J. M., & Mont, L. (2022). Conduction system pacing vs biventricular pacing in heart failure and wide qrs patients. JACC: Clinical Electrophysiology, 8(11), 1431–1445. https://doi.org/10.1016/j.jacep.2022.08.001
