Efficacy Comparison Between Conventional and Probe Methods for Left Bundle Branch Area Pacing

Left bundle branch area pacing (LBBAP) is a novel physiological pacing technique, but its relatively complex procedure limits its widespread clinical application. To compare the clinical efficacy of probe-LBBAP (p-LBBAP, a method involving pre-positioning a ventricular lead guidewire to the optimal physiological pacing site in the interventricular septum before guiding ventricular lead implantation) and conventional LBBAP (c-LBBAP) in patients undergoing physiological cardiac pacing. A retrospective analysis was conducted on 20 patients who received physiological pacing. Based on the LBBAP lead implantation technique, patients were divided into the p-LBBAP group (n = 10) and the c-LBBAP group (n = 10). Baseline clinical data, including medical history, QRS duration, and echocardiographic parameters, were collected. Procedural reports were reviewed to compare intraoperative LBBAP lead implantation time, fluoroscopy time, stimulus to left ventricular activation time (Sti-LVAT), postoperative paced QRS duration, pacemaker parameters, and echocardiographic outcomes. A total of 20 patients were included, with a mean age of (69.50 ± 10.76) years, including 11 males (55%, 11/20). The cohort was divided into the c-LBBAP group (n = 10) and the p-LBBAP group (n = 10). Compared with the c-LBBAP group, the p-LBBAP group showed significantly reduced LBBAP lead implantation time ([288.70 ± 59.99] s vs. [370.6 ± 59.11] s, p = 0.007) and fluoroscopy time ([330.80 ± 52.67] s vs. [383.2 ± 49.04] s, p = 0.034). Regarding pacemaker parameters, no statistically significant differences were observed between the p-LBBAP and c-LBBAP groups in postoperative ventricular lead threshold (p = 0.721) or impedance (p = 0.725). Similarly, no significant differences were found in Postoperative paced QRS duration (p = 0.783) and paced QRS narrowing rate (p = 0.869). At the 6-month follow-up, LBBAP lead thresholds and impedance remained stable in both groups. Echocardiographic follow-up revealed no significant difference in the improvement of left ventricular ejection fraction (LVEF) (p = 0.692). No procedure-related complications occurred in either group. In physiological pacing procedures, the p-LBBAP technique significantly reduces LBBAP lead implantation time and fluoroscopy time while maintaining stable lead thresholds and impedance during follow-up, demonstrating its reliability as a physiological pacing approach.