{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T22:14:14Z","timestamp":1791670454872,"version":"4.3.4"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2024,1,30]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Left bundle branch area pacing (LBBAP) may be associated with greater improvement in left ventricular ejection fraction and reduction in death or heart failure hospitalization compared with biventricular pacing (BVP) in patients requiring cardiac resynchronization therapy. We sought to compare the occurrence of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and new-onset atrial fibrillation (AF) in patients undergoing BVP and LBBAP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>The I-CLAS study (International Collaborative LBBAP Study) included patients with left ventricular ejection fraction \u226435% who underwent BVP or LBBAP for cardiac resynchronization therapy between January 2018 and June 2022 at 15 centers. We performed propensity score\u2013matched analysis of LBBAP and BVP in a 1:1 ratio. We assessed the incidence of VT\/VF and new-onset AF among patients with no history of AF. Time to sustained VT\/VF and time to new-onset AF was analyzed using the Cox proportional hazards survival model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 1778 patients undergoing cardiac resynchronization therapy (BVP, 981; LBBAP, 797), there were 1414 propensity score\u2013matched patients (propensity score\u2013matched BVP, 707; propensity score\u2013matched LBBAP, 707). The occurrence of VT\/VF was significantly lower with LBBAP compared with BVP (4.2% versus 9.3%; hazard ratio, 0.46 [95% CI, 0.29\u20130.74];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). The incidence of VT storm (&gt;3 episodes in 24 hours) was also significantly lower with LBBAP compared with BVP (0.8% versus 2.5%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.013). Among 299 patients with cardiac resynchronization therapy pacemakers (BVP, 111; LBBAP, 188), VT\/VF occurred in 8 patients in the BVP group versus none in the LBBAP group (7.2% versus 0%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). In 1194 patients with no history of VT\/VF or antiarrhythmic therapy (BVP, 591; LBBAP, 603), the occurrence of VT\/VF was significantly lower with LBBAP than with BVP (3.2% versus 7.3%; hazard ratio, 0.46 [95% CI, 0.26\u20130.81];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.007). Among patients with no history of AF (n=890), the occurrence of new-onset AF &gt;30 s was significantly lower with LBBAP than with BVP (2.8% versus 6.6%; hazard ratio, 0.34 [95% CI, 0.16\u20130.73];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.008). The incidence of AF lasting &gt;24 hours was also significantly lower with LBBAP than with BVP (0.7% versus 2.9%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.015).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>LBBAP was associated with a lower incidence of sustained VT\/VF and new-onset AF compared with BVP. This difference remained significant after adjustment for differences in baseline characteristics between patients with BVP and LBBAP. Physiological resynchronization by LBBAP may be associated with lower risk of arrhythmias compared with BVP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.123.067465","type":"journal-article","created":{"date-parts":[[2023,11,11]],"date-time":"2023-11-11T10:15:09Z","timestamp":1699697709000},"page":"379-390","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":72,"title":["Arrhythmic Risk in Biventricular Pacing Compared With Left Bundle Branch Area Pacing: Results From the I-CLAS Study"],"prefix":"10.1161","volume":"149","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8645-4817","authenticated-orcid":true,"given":"Bengt","family":"Herweg","sequence":"first","affiliation":[{"name":"University of South Florida Morsani College of Medicine, Tampa (B.H., R.B., M.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7999-476X","authenticated-orcid":true,"given":"Parikshit S.","family":"Sharma","sequence":"additional","affiliation":[{"name":"Rush University Medical Center, Chicago, IL (P.S.S., C.D., S.C.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6783-0138","authenticated-orcid":true,"given":"\u00d3scar","family":"Cano","sequence":"additional","affiliation":[{"name":"Hospital Universitari i Polit\u00e8cnic La Fe and Centro de Investigaciones Biom\u00e9dicas en RED en Enfermedades Cardiovasculares, Valencia, Spain (O.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7059-425X","authenticated-orcid":true,"given":"Shunmuga Sundaram","family":"Ponnusamy","sequence":"additional","affiliation":[{"name":"Velammal Medical College Hospital and Research Institute, Madurai, India (S.S.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2673-3918","authenticated-orcid":true,"given":"Francesco","family":"Zanon","sequence":"additional","affiliation":[{"name":"Santa Maria Della Misericordia Hospital, Rovigo, Italy (F.Z., L.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3318-6601","authenticated-orcid":true,"given":"Marek","family":"Jastrzebski","sequence":"additional","affiliation":[{"name":"First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland (M.J., P.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5891-6589","authenticated-orcid":true,"given":"Jiangang","family":"Zou","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Nanjing Medical University, Cardiology, Jiangsu, China (J.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9688-1604","authenticated-orcid":true,"given":"Mihail G.","family":"Chelu","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Nanjing Medical University, Cardiology, Jiangsu, China (J.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8818-5964","authenticated-orcid":true,"given":"Kevin","family":"Vernooy","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Netherlands (K.V., A.v.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2775-5126","authenticated-orcid":true,"given":"Zachary I.","family":"Whinnett","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, United Kingdom (Z.I.W., A.M.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3303-1490","authenticated-orcid":true,"given":"Girish M.","family":"Nair","sequence":"additional","affiliation":[{"name":"University of Ottawa Heart Institute, ON, Canada (G.M.N., M.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3988-6721","authenticated-orcid":true,"given":"Manuel","family":"Molina-Lerma","sequence":"additional","affiliation":[{"name":"Hospital Universitario Virgen de las Nieves, Granada, Spain (M.M.-L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3523-6358","authenticated-orcid":true,"given":"Karol","family":"Curila","sequence":"additional","affiliation":[{"name":"Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic 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