Left Bundle Branch Area Pacing as an Upgrade for Patients With Pacing-Induced Ventricular Dysfunction

Area of Science:

• Cardiology
• Electrophysiology
• Heart Failure Management

Background:

• Pacing-induced cardiomyopathy (PIC) affects up to 30% of patients with conventional right ventricular (RV) pacing.
• Cardiac resynchronization therapy (CRT) is often required, but Left bundle branch area pacing (LBBAP) presents a physiological alternative.
• The efficacy of LBBAP for upgrading patients with PIC is not well-established.

Purpose of the Study:

• To evaluate the safety and effectiveness of LBBAP as an upgrade strategy for patients diagnosed with pacing-induced cardiomyopathy (PIC).
• To assess the impact of LBBAP on electrical remodeling, echocardiographic parameters, and clinical outcomes in patients with PIC.

Main Methods:

• Retrospective analysis of 31 patients who underwent LBBAP upgrade for PIC from June 2020 to September 2024.
• Assessment of procedural success rates, changes in QRS duration, left ventricular ejection fraction (LVEF), and clinical outcomes including heart failure hospitalizations and mortality.
• Data analysis focused on electrical and functional improvements post-LBBAP implantation.

Main Results:

• LBBAP implantation was successful in 97% of patients (30 out of 31).
• Significant reduction in QRS duration (175 ms to 130 ms, p < 0.001) and improvement in LVEF (33% to 42%, p < 0.001) were observed after a median follow-up of 19 months.
• Low rates of heart failure hospitalization (9%) and mortality (16%) were reported during the follow-up period.

Conclusions:

• Left bundle branch area pacing (LBBAP) demonstrates to be a safe and effective upgrade strategy for patients suffering from pacing-induced cardiomyopathy (PIC).
• LBBAP leads to significant electrical and functional cardiac improvements in this patient population.
• Further research is warranted to compare the long-term efficacy of LBBAP against traditional biventricular pacing for PIC management.