Left bundle branch area pacing (LBBAP) Auto Threshold algorithms Evaluation for Conduction System Pacing: The LATECS...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Automated threshold measurements (ATM) and output adaptation enhance cardiac implantable device (CIED) safety and follow-up.
• Existing ATM algorithms are validated for conventional pacing but not for permanent His Pacing.
• Left bundle branch area pacing (LBBAP) is an emerging technique for physiologic cardiac stimulation.

Purpose of the Study:

• To assess the applicability of ATM in the setting of LBBAP.
• To compare manual threshold measurements with ATM-derived thresholds for LBBAP leads.

Main Methods:

• A prospective, observational trial enrolled consecutive patients receiving ATM-capable CIED and LBBAP.
• Pacing thresholds were compared manually and via ATM at 3 months post-implant.
• Subsequent remote follow-up was conducted when available.

Main Results:

• Forty-five patients were enrolled, and ATM for LBBAP leads was consistently effective.
• Mean manual LBBAP capture threshold was 0.66 ± 0.19 V, versus 0.64 ± 0.19 V with ATM.
• TOST analysis confirmed equivalence (p = .66); ATM was effective in follow-up with no adverse events.

Conclusions:

• ATM algorithms are equivalent to manual testing for determining LBBAP capture thresholds.
• ATM can be reliably employed for patients receiving LBBAP CIED.
• This supports the use of ATM for improved safety and follow-up in LBBAP.