Left Bundle Branch Area Pacing as an Upgrade for Patients With Pacing-Induced Ventricular Dysfunction
Vázquez-González J1, Toquero-Ramos J1, García-Izquierdo E1
1Electrophysiology Unit, Cardiology Service, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
Background:
Pacing-induced cardiomyopathy (PIC) occurs in up to 30% of patients with conventional right ventricular (RV) pacing, often requiring upgrade to cardiac resynchronization therapy (CRT). Left bundle branch area pacing (LBBAP) offers a physiological alternative to biventricular pacing, but its role in PIC upgrades remains underexplored.
Methods:
We retrospectively analyzed 31 patients who underwent LBBAP upgrades for PIC between June 2020 and September 2024. Procedural success, electrical remodeling, echocardiographic changes, and clinical outcomes were assessed.
Results:
LBBAP was successful in 30 (97%) cases. Average procedure time was 80 (60-120) min. QRS duration significantly decreased (175 ± 17 ms to 130 ± 18 ms, p < 0.001). After a median 19 months of follow up, left ventricular ejection fraction (LVEF) improved from 33 ± 8% to 42 ± 8% (p < 0.001). Three patients (9%) were hospitalized for heart failure, and five (16%) died during follow-up.
Conclusion:
LBBAP is a safe and effective upgrade strategy for PIC, offering significant electrical and functional improvements. Further studies are needed to confirm its long-term benefits compared to biventricular pacing.
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