| Sumario: | Background: Left bundle branch area pacing (LBBAP) and endocardial resynchronization (Endo‐CRT) are alternatives to biventricular pacing for cardiac resynchronization therapy (CRT). Objective: To compare the outcomes of LBBAP versus Endo‐CRT using conventional pacing leads. Methods: Patients with heart failure (HF) undergoing CRT with LBBAP or Endo‐CRT were included. The primary efficacy outcome was a composite of HF‐related hospitalization and all‐cause mortality. The primary safety outcome was any procedure‐related complication. Secondary outcomes included procedural characteristics, electrocardiographic, and echocardiographic parameters. Results: A total of 223 patients (LBBAP n = 197, Endo‐CRT n = 26; mean age 69 ± 10.3 years, 32.3% female) were included. Patients in the LBBAP group had lower NYHA class, shorter preprocedural QRS durations (161 [142–183] vs. 180 [170–203] msec, p <.001), and a lower preprocedural spironolactone use (57.4% vs. 84.6%, p =.009) than patients in the Endo‐CRT group. Fluoroscopy time was significantly shorter in patients undergoing LBBAP (11.4 [7.2–20] vs. 23 [14.2–34.5] min; p <.001). There was no significant difference in the primary efficacy outcome between both groups (Cox proportional HR 1.21, 95% CI 0.635–2.31; p =.56). During follow‐up, patients undergoing LBBAP had a lower incidence of stroke than patients in the Endo‐CRT group (0% vs. 11.5%, p =.001). Postprocedural LVEF (35% [25–45] vs. 40% [20–55]; p =.307) and change in LVEF (7% [0–20] vs. 11% [2–18]; p =.384) were similar between the LBBAP and the Endo‐CRT groups, respectively. Conclusion: LBBAP and Endo‐CRT using conventional leads are associated with similar mortality and HF‐related hospitalization, as well as improvements in LVEF. Endo‐CRT is associated with longer fluoroscopy times and a higher risk of stroke.
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