Left bundle branch area pacing in patients with atrioventricular conduction disease: A prospective multicenter study
Alexandre Raymond-Paquin1, Atul Verma2, Jeffrey Kolominsky3
1Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Montreal Heart Institute, Department of Medicine, Université de Montréal, Québec, Canada.
Insights
Left bundle branch area pacing (LBBAP) offers a high success rate for patients with atrioventricular (AV) conduction disease. This study demonstrates LBBAP
Area of Science:
- Electrophysiology
- Cardiology
- Medical Device Technology
Background:
- His-bundle pacing (HBP) shows limited success (52%-76%) in patients with infranodal atrioventricular (AV) conduction disease.
- Left bundle branch area pacing (LBBAP) efficacy in this patient group is not well-established.
Purpose of the Study:
- To assess the feasibility, safety, and electrophysiological characteristics of LBBAP in patients diagnosed with AV conduction disease.
- To compare LBBAP outcomes with existing data for His-bundle pacing.
Main Methods:
- A cohort of patients with AV conduction disease undergoing pacemaker implantation were evaluated for LBBAP suitability.
- Data collected included baseline demographics, procedural success rates, electrophysiological parameters, and complications.
- Follow-up assessments monitored lead parameters and patient outcomes.
Main Results:
- LBBAP achieved a high procedural success rate of 93% (340/364 patients).
- Success rates were consistent across various AV conduction disease indications and QRS durations.
- Mean pacing thresholds remained stable throughout the follow-up period, with a low rate of acute lead dislodgement (1.2%).
Conclusions:
- LBBAP is a safe and feasible pacing strategy for patients with AV conduction disease.
- LBBAP demonstrates high and stable success rates across the spectrum of AV conduction disease, outperforming HBP.
- Stable lead parameters suggest long-term reliability of LBBAP.
Background:
The reported success rate of His-bundle pacing (HBP) in patients with infranodal atrioventricular (AV) conduction disease is only 52%-76%. The success rate of left bundle branch area pacing (LBBAP) in this cohort is not well studied.
Objective:
The purpose of this study was to evaluate the feasibility, safety, and electrophysiological characteristics of LBBAP in patients with AV conduction disease.
Methods:
Patients with AV conduction disease referred for pacemaker implantation at 2 centers between February 2019 and June 2021 were considered for LBBAP. Baseline demographic characteristics, procedural success rates, electrophysiological parameters, and complications were assessed.
Results:
LBBAP was successful in 340 of 364 patients (93%). Mean age was 72 ± 13 years, and mean follow-up was 331 ± 244 days. Pacing indications were Mobitz I in 27 patients (7%), Mobitz II or 2:1 AV block or high-grade AV block in 94 patients (26%), complete heart block in 199 patients (55%), and sick sinus syndrome with isolated bundle branch block in 44 patients (12%). Left bundle branch block and right bundle branch block were present in 57 patients (16%) and 140 patients (38%), respectively. Procedural success rates did not differ between indications (92.6%, 93.6%, 92.9%, and 95%, respectively) or between patients with narrow (<120 ms) vs wide QRS (≥120 ms). Mean LBBAP threshold was 0.77 ± 0.34 V at 0.4 ms at implant and remained stable during follow-up. There were 4 (1.2%) acute LBBAP lead dislodgments.
Conclusion:
LBBAP is safe and feasible with high success rates for patients with AV conduction disease. In contrast to HBP, LBBAP success rates remain high over the entire spectrum of AV conduction disease, and lead parameters remain stable during follow-up.
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The pacemaker cells are located in two primary nodes: the sinoatrial (SA) node and the atrioventricular (AV) node. The SA node pacemaker cells can autonomously depolarize, triggering an action potential that leads to the...