Establishing a left bundle branch area pacing program: Results from a high-volume pacing center

Left bundle branch area pacing (LBBAP) is a technique suitable for treating both symptomatic bradycardia and cardiac resynchronization therapy (CRT). Our study aims to describe the first experience of LBBAP in a high-volume cardiac implantable electronic device (CIED) center.

This prospective single-center observational registry included consecutive patients who underwent pacemaker implantation with LBBAP technique for sinus node disease, bradycardia and CRT indications between January 2023 and January 2024. Procedural data, outcomes, and lead parameters were recorded at hospital discharge, at one and six months of follow-up.

A total of 164 consecutive patients undergoing LBBAP implantation were included, of whom 142 had a stylet-driven lead. LLBAP was achieved in 94.5% patients. Average QRS duration was 139.8±33.4 ms. Complete atrioventricular block was the most common indication (42.7%). CRT was performed in 24 (14.5%) patients. Mean procedural duration was 82.7±24.4 min and mean fluoroscopy time was 13.7±7.1 min. Average LVAT was 78.8±8.7 ms and paced QRS width 114.8±14.4 ms. Median acute R-wave amplitude was 14.0 mV, pacing threshold was 0.5 V and impedance 526 Ω. No relevant per-operative complications occurred. After one month of follow-up, median pacing threshold had significantly increased to 0.75 V (p<0.001) while R-wave amplitude and impedance remained unchanged (p=0.242 and p=0.101 respectively). During follow-up, no changes occurred in the evaluated parameters. Loss of left bundle branch capture occurred in five patients and macro-dislodgement in 2.

LBBAP is a feasible pacing technique which reduces QRS duration and improves LV synchrony and can be adopted at most centers, with favorable success rates and safety profile.