Left bundle branch area pacing: longitudinal data on pacing efficacy

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Abstract Background Left bundle branch area pacing (LBBAP) has gained recognition as a technique for physiological ventricular pacing that maintains left ventricular (LV) synchrony. Although procedural characteristics are increasingly documented, information on longer terms lead stability remains scarce. We aimed to evaluate the procedural features and the stability of pacing parameters over a mid-term follow-up. Methods Single centre study including consecutive patients undergoing LBBAP from 2021 to 2024. Data on procedural characteristics, lead parameters, and final QRS duration were gathered immediately post-implantation and throughout follow-up. Criteria for confirming conduction system capture with LBBAP was defined according to current recommendations. Results Overall, 205 consecutive patients were included (mean age 77±12 years and 64% male). Procedural duration was 63min (IQR 51-80) and fluoroscopy time was 4.9min (IQR 2.9-7.8). Median LVAT was 86ms (IQR 78-96), paced QRS immediately after implantation was 112ms (IQR 104-120) and interpeak V1-V6 was 38ms (30-44). Acute R-wave amplitude and pacing threshold were 11.4 mV (IQR 6.9-15.7) and 0.5 mV (IQR 0.5-0.7), respectively. One case of in-hospital ischemic stroke associated with withholding anticoagulation in a patient with atrial fibrillation and 1 case of electrode dislocation with successful replacement were reported at discharge. No other major complications were reported. Over a median follow-up of 7.9 months (IQR 2.3-15.3), both the pacing threshold (0.6 mV [IQR 0.5-0.75]) and R-wave amplitude [12.3 mV (IQR 9.0-19.3)] remained stable. QRS duration, a surrogate of LV synchrony, remained narrow: 120ms (IQR 110-122). Conclusion In this cohort, LBBAP proved feasible, demonstrating excellent pacing parameters that remained stable throughout the mid-term follow-up. QRS duration remained consistently short, further underscoring the potential of this technique in maintaining LV synchrony.

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