Clinical Features and Outcomes of Long-Term Lead Performance by Left Bundle Branch Pacing

Left bundle branch pacing (LBBP) is an emerging physiological pacing technique that expanded in recent reports. The long-term safety and feasibility of LBBP lack adequate evaluation.The study aimed to evaluate the long-term lead performance and clinical outcomes of LBBP.We retrospectively enrolled 123 consecutive patients scheduled for LBBP implantation from January to December 2018. The pacing parameters, electrocardiograms, echocardiographic measurements, and complications associated with LBBP were tracked at implant and follow-up.LBBP was successfully performed in 110 of 123 (89.4%) patients. Left ventricular end-diastolic dimension (LVEDd) and left ventricular ejection fraction (LVEF) improved from baseline in patients with reduced LVEF (n = 29; LVEDd, 55.6 ± 8.1 mm versus 63.4 ± 4.9 mm, P < 0.001; LVEF, 51.6% ± 13.6% versus 33.7% ± 5.5%, P < 0.001) while no significant change was found in patients with preserved LVEF (n = 81; LVEDd, 49.6 ± 12.0 mm versus 51.2 ± 6.0 mm, P = 0.38; LVEF, 65.8% ± 7.9% versus 65.8% ± 7.3%, P = 0.99). In seven patients, LBBP lead protuberance into the LV cavity was observed, with a mean distance between the screw tip and the LV septum of 3.0 ± 0.8 mm (range from 1.8 to 3.9 mm). The LBBP parameters remained stable.LBBP is a novel physiological, safe, and effective pacing technique for patients with atrioventricular block. Lower BMI, diabetes and thinner interventricular septum (IVS) thickness are associated with mechanical complications.