Initial experience, feasibility and safety of permanent left bundle branch pacing: results from a prospective single-centre study

• Published in: Netherlands heart journal Vol. 30; no. 5; pp. 258 - 266
• Main Authors: Rademakers, L. M., van den Broek, J. L. P. M., Op ’t Hof, M., Bracke, F. A.
• Format: Journal Article
• Language: English
• Published: Houten Bohn Stafleu van Loghum 01.05.2022; Springer Nature B.V
• Subjects: Ablation; Cardiac arrhythmia; Cardiology; Cardiovascular disease; Coronary vessels; Electrocardiography; Heart failure; Medical Education; Medicine; Medicine & Public Health; Morphology; Mortality; Original; Original Article; Pacemakers; Patients; Physiology; Success; Minneapolis Minnesota; United States > US; Bradycardia pacing; Cardiac resynchronisation therapy; Physiologic pacing; Left bundle branch pacing
• ISSN: 1568-5888; 1876-6250
• DOI: 10.1007/s12471-021-01648-6

Background Left bundle branch (LBB) pacing is a novel pacing technique which may serve as an alternative to both right ventricular pacing for symptomatic bradycardia and cardiac resynchronisation therapy (CRT). A substantial amount of data is reported by relatively few, highly experienced centres. This study describes the first experience of LBB pacing in a high-volume device centre. Methods Success rates (i.e. the ability to achieve LBB pacing), electrophysiological parameters and complications at implant and up to 6 months of follow-up were prospectively assessed in 100 consecutive patients referred for various pacing indications. Results The mean age was 71 ± 11 years and 65% were male. Primary pacing indication was atrioventricular (AV) block in 40%, CRT in 42%, and sinus node dysfunction or refractory atrial fibrillation prior to AV node ablation in 9% each. Baseline left ventricular ejection fraction was < 50% in 57% of patients, mean baseline QRS duration 145 ± 34 ms. Overall LBB pacing was successful in 83 of 100 (83%) patients but tended to be lower in patients with CRT pacing indication (69%, p  = ns). Mean left ventricular activation time (LVAT) during LBB pacing was 81 ms and paced QRS duration was 120 ± 19 ms. LBB capture threshold and R‑wave sense at implant was 0.74 ± 0.4 mV at 0.4 ms and 11.9 ± 5.9 V and remained stable at 6‑month follow-up. No complications occurred during implant or follow-up. Conclusion LBB pacing for bradycardia pacing and resynchronisation therapy can be easily adopted by experienced implanters, with favourable success rates and safety profile.