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

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Left bundle branch area pacing (LBBAP) offers a promising alternative for bradycardia and cardiac resynchronization therapy (CRT).
• Assessing the initial experience with LBBAP in a high-volume cardiac implantable electronic device (CIED) center is crucial for understanding its clinical utility.

Purpose of the Study:

• To evaluate the feasibility, procedural outcomes, and safety profile of LBBAP in a large cohort of patients.
• To assess the impact of LBBAP on QRS duration and left ventricular (LV) synchrony.

Main Methods:

• A prospective observational registry of 164 consecutive patients undergoing LBBAP implantation between January 2023 and January 2024.
• Data collection included procedural parameters, lead characteristics, and clinical outcomes at hospital discharge and at one and six months post-implantation.

Main Results:

• Successful LBBAP was achieved in 94.5% of patients, with complete atrioventricular block being the most common indication (42.7%).
• Mean procedural duration was 82.7 minutes with a mean fluoroscopy time of 13.7 minutes. Paced QRS duration averaged 114.8 ms.
• No major periprocedural complications were observed. Transient loss of capture occurred in 5 patients, and 2 experienced lead dislodgement during follow-up.

Conclusions:

• LBBAP is a feasible and safe pacing technique with high success rates.
• The procedure effectively reduces QRS duration and improves LV synchrony, making it a viable option for various cardiac conditions.
• LBBAP can be adopted by most centers, offering favorable outcomes for patients requiring bradycardia pacing or CRT.