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Updated: Jul 25, 2025

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Left Bundle Branch Area Pacing and Atrioventricular Node Ablation in a Single-Procedure Approach for Elderly Patients

Jesse H J Rijks1, Theo Lankveld1,2, Randolph Manusama1,2

  • 1Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands.

Journal of Clinical Medicine
|June 28, 2023
PubMed

Insights

Left bundle branch area pacing combined with AV node ablation is a safe and feasible single procedure for elderly patients with symptomatic atrial fibrillation. This approach offers physiological pacing, potentially avoiding dyssynchrony.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Permanent pacemaker and AV node ablation (pace-and-ablate) is standard for symptomatic atrial fibrillation in the elderly.
  • Left bundle branch area pacing (LBBAP) offers physiological pacing, potentially mitigating RV pacing-induced dyssynchrony.

Purpose of the Study:

  • To investigate the feasibility and safety of performing LBBAP and AV node ablation in a single procedure in elderly patients.
  • To assess complications and lead stability of this combined approach.

Main Methods:

  • Consecutive elderly patients with symptomatic atrial fibrillation undergoing pace-and-ablate were included.
  • LBBAP and AV node ablation were performed as a single procedure.
  • Procedure-related complications and lead stability were monitored post-procedure.

Main Results:

  • 25 elderly patients (mean age 79.2 years) underwent successful LBBAP.
  • AV node ablation was performed concurrently in 88% of patients.
  • No procedure-related complications or lead stability issues were observed.

Conclusions:

  • Single-procedure LBBAP combined with AV node ablation is feasible and safe in elderly patients with symptomatic atrial fibrillation.
  • This approach may offer a physiological pacing alternative for this patient population.
Abstract

Keywords:
atrial fibrillationatrioventricular node ablationconduction system pacingelderlyleft bundle branch area pacingrate controlsymptom control

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