Left bundle branch area pacing outcomes: the multicentre European MELOS study
Marek Jastrzębski1, Grzegorz Kiełbasa1, Oscar Cano2,3
1First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Jakubowskiego 2, 30-688 Krakow, Poland.
European Heart Journal
|August 18, 2022
Summary
Permanent transseptal left bundle branch area pacing (LBBAP) is feasible for bradyarrhythmia and heart failure. This large study shows good success rates but highlights the need for improved safety and efficacy in heart failure patients.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Permanent transseptal left bundle branch area pacing (LBBAP) is an emerging technique for cardiac pacing.
- Existing data on LBBAP safety, feasibility, and capture types are limited to small studies.
- Large-scale, multicenter data are needed to evaluate LBBAP outcomes comprehensively.
Purpose of the Study:
- To evaluate the safety, feasibility, and outcomes of permanent transseptal left bundle branch area pacing (LBBAP) in a large, international, multicenter cohort.
- To identify predictors of LBBAP lead implantation failure.
- To characterize the capture types and acute performance of LBBAP devices.
Main Methods:
- A registry-based observational study involving 2533 patients undergoing attempted LBBAP implantation across 14 European centers.
- Data collection included patient demographics, indications for pacing, procedural success rates, capture types, lead performance, and complications.
- Statistical analysis identified independent predictors of LBBAP lead implantation failure.
Main Results:
- LBBAP lead implantation success rates were 92.4% for bradyarrhythmia and 82.2% for heart failure.
- The learning curve plateaued after approximately 250 cases.
- Left bundle fascicular capture was the predominant type (69.5%).
- Mean follow-up capture thresholds and sensing were stable.
- The overall complication rate was 11.7%, with 8.3% related to the transseptal route.
Conclusions:
- Permanent transseptal left bundle branch area pacing (LBBAP) is a feasible primary pacing technique for both bradyarrhythmia and heart failure.
- Improvements in success rates and safety are needed, particularly for heart failure patients.
- Randomized trials are essential to confirm the clinical benefits of LBBAP.
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