Feasibility and Safety of Left Bundle Branch Pacing for Advance Aged Patients: A Multicenter Comparative Study
Zhongyuan Ren1, Binni Cai2, Songyun Wang3
1Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Insights
Left bundle branch pacing (LBBP) is safe and effective for elderly patients over 80. This study found comparable midterm safety and prognosis in older adults compared to younger patients, with similar complication rates.
Area of Science:
- Cardiology
- Electrophysiology
- Geriatric Medicine
Background:
- Left bundle branch pacing (LBBP) offers physiological pacing but its safety in elderly patients (>80 years) is unknown.
- Elderly individuals face higher risks with invasive procedures.
- This study addresses the safety and efficacy of LBBP in patients over 80.
Purpose of the Study:
- To investigate the safety and efficacy of LBBP in patients aged over 80 years.
- To compare LBBP outcomes in elderly patients versus younger individuals.
- To evaluate pacing parameters, complications, and prognosis after LBBP in different age groups.
Main Methods:
- A comparative study included 346 patients with symptomatic bradycardia undergoing LBBP from Dec 2017 to June 2019.
- Patients were divided into two groups: <80 years (n=184) and >80 years (n=162).
- Safety and prognosis were assessed via pacing parameters, complications, and clinical events during a mean 20-month follow-up.
Main Results:
- Elderly patients had poorer baseline cardiac and renal function but achieved successful LBBP with comparable fluoroscopic time and QRS duration to younger patients.
- Midterm follow-up showed stable pacing parameters, though elderly patients had higher thresholds and impedance.
- Procedure-related complication rates (4.4% vs. 3.8%) and major adverse cardiocerebrovascular events (7.1% vs. 11.9%) were similar between younger and elderly groups.
Conclusions:
- LBBP provides physiological pacing in patients over 80 with comparable midterm safety and prognosis to younger patients.
- LBBP is a viable option for physiological pacing in the elderly population.
- Further research is needed to confirm long-term safety and benefits of LBBP in elderly individuals.
Abstract:
Background: Left bundle branch pacing (LBBP) has been shown to be a safe and effective means to achieve physiological pacing. However, elderly patients have increased risks from invasive procedures and the risk of LBBP in elderly patients is not known. We aimed to investigate the safety and efficacy of LBBP in elderly patients >80 years of age. Methods: From December 2017 to June 2019, 346 consecutive patients with symptomatic bradycardia, 184 patients under 80 years of age and 162 over 80 years, were included and underwent LBBP. The safety and prognosis of LBBP were comparatively evaluated by measured pacing parameters, periprocedural complications, and follow-up clinical events. Results: Compared with the younger, the elderly group had worse baseline cardiac and renal function. LBBP was achieved successfully in both groups with comparable fluoroscopic time and paced QRS duration (110.0 [102.0, 118.0] ms for the young vs. 110.0 [100.0, 120.0] ms for the elderly, P = 0.874). Through a follow-up of 20.0 ± 6.1 months, pacing parameters were stable while higher threshold and impedance were observed in the elderly group. In the evaluation of safety, overall procedure-related complication rates were comparable (4.4 vs. 3.8%, young vs. elderly). For prognosis, similar rates of major adverse cardiocerebrovascular events (7.1 vs. 11.9%, young vs. elderly) were observed. Conclusions: Compared to younger patients, LBBP could achieve physiological pacing in patients over 80 with comparable midterm safety and prognosis. Long-term safety and benefits of LBBP, however, necessitate further evaluation.
