Reduction of mitral regurgitation in heart failure patients after left bundle branch area pacing CRT implantation

Abstract

Mitral regurgitation(MR) in patients with reduced left ventricle ejection fraction is associated with negative outcomes. We present mid-term outcomes of LBBAP-CRT implantation to evaluate improvement of MR in patients with heart failure and left bundle branch block.

Methods: Consecutive patients with left ventricle ejection fraction<35% and LBBB, despite GDMT for 3 months, who underwent LBBAP-CRT. Improvement of MR was defined as a reduction of at least one grade in regurgitation severity.

Results: Total 30 patients were included. Mean age 58,3±9,7 years. Mean QRS duration-182,5±17,4 ms; End-diastolic volume(EDV)-210±69,5ml; end-systolic volume(ESV)-158,2±64,1ml; left ventricle ejection fraction(LV EF)-25,6±7,2%; left atrium(LA) volume-88,7±31,2ml; NTproBNP level-2120,3±2440pg/ml.

All patients were divided into 4 groups, based on severity of MR: absence of MR- 9 patients(30%); mild MR-9 patients(30%); moderate MR-7 patients(27%); severe MR-4 patients(13%). LBBAP resulted in significant reduction of QRS duration(111,3±12,1ms). Echocardiography was performed after 3, 6, 12 months. Structural remodeling resulted in decreased LA volume(66±21ml), EDV(139,31±46,6ml), ESV(88,1±38,5ml), increasing of LV EF(46,8±7,7%). Severity of MR was decreased at least of 1 grade in 16(76%) patients. In 3 patients with severe MR grade of regurgitation decreased to mild (1) and trivial (2). In 7 patients with moderate MR, valvular insufficiency was disappeared. 1 patient showed poor response for LBBAP-CRT and underwent valvular surgery

Conclusion: LBBAP obtain good electrical resynchronization and significant improvement of MR. Long term data and randomisation with conventional biventricular pacing needed to increase level of evidence of the csp-crtMR