Outcomes of left bundle branch area pacing upgrade in patients with right ventricular pacing-induced cardiomyopathy

Pacemaker-induced cardiomyopathy (PICM) is an increasingly recognized consequence of right ventricular pacing, which can lead to a significant decline in left ventricular ejection fraction (LVEF) and development of heart failure symptoms. Left bundle branch area pacing (LBBAP) is an effective strategy for cardiac resynchronization therapy, but its role in PICM is not well defined.

This study sought to determine what the clinical and echocardiographic responses were in patients with PICM who underwent LBBAP.

This was an observational, retrospective, multicenter study. Patient- and lead-related characteristics along with clinical and echocardiographic data were tracked.

Sixty-four patients were included, with a mean LVEF of 36.5 ± 8.8 and New York Heart Association status of 2.72 ± 0.68 before LBBAP. Successful LBBAP was achieved with a significant reduction in QRS duration (172.5 ± 21.9 to 133.4 ± 19.2 ms, P < .001), which was associated with an increase in LVEF by an average of 11.0% ± 17.7% (P < .001) and an improvement in New York Heart Association status (2.72 ± 0.68 to 1.75 ± 0.6, P < .001). Lead extraction was performed in 18 of 64 patients (28%). Outcomes did not significantly differ between patients with ≥90% and <90% right ventricular pacing burdens.

This study-the largest series investigating LBBAP for PICM to date-supports LBBAP as a viable, effective alternative to conventional cardiac resynchronization therapy in PICM, offering improvements in cardiac function and patient symptoms. However, larger randomized trials are needed to validate these findings in a broader, more heterogeneous population.