Left Bundle Branch Area Pacing in Older Patients: A New Opportunity?

Area of Science:

• Cardiology
• Electrophysiology
• Geriatrics

Background:

• Heart failure (HF) management relies on resynchronization therapy.
• Left bundle branch area pacing (LBBAP) offers physiological stimulation via a single ventricular catheter.
• Limited data exists on LBBAP efficacy in patients aged ≥75 years.

Purpose of the Study:

• To review the application and outcomes of LBBAP in older adults (≥75 years).
• To assess the safety and effectiveness of LBBAP in elderly HF patients.
• To identify research gaps, particularly concerning cardiac amyloidosis.

Main Methods:

• PubMed literature search for studies on LBBAP in older patients.
• Inclusion criteria: patients aged ≥75 years.
• Inclusion of Italian national registry data for statistical context.

Main Results:

• LBBAP is safe and effective in older HF patients, with outcomes similar to younger cohorts.
• Evidence suggests LBBAP may be cost-effective in this population.
• Data on LBBAP for cardiac amyloidosis remains inconclusive.

Conclusions:

• LBBAP is a valuable therapeutic option for patients across all age groups.
• Patient frailty in the elderly requires careful consideration for LBBAP application.
• Future integration with defibrillator capabilities could expand LBBAP's utility.