Left Bundle Branch Area Pacing Outcomes
- Left bundle branch area pacing (LBBAP) lead implantation success rate for bradyarrhythmia indication was 92% and heart failure indication was 82%.
- The predominant LBBAP capture type was left bundle fascicular capture (70%), followed by left ventricular septal capture (22%) and proximal left bundle branch capture (9%).
What are the outcomes of permanent transseptal left bundle branch area pacing (LBBAP)?
MELOS (Multicentre European Left Bundle Branch Area Pacing Outcomes Study) is a 14-center registry-based observational study of patients in whom LBBAP device implantation was attempted for any indication.
The study included a total of 2,533 patients (mean age 74 years, female 58%, heart failure 28%). LBBAP lead implantation success rate for bradyarrhythmia indication was 92% and heart failure indication was 82%. Independent predictors of LBBAP lead implantation failure were heart failure, broad baseline QRS, and left ventricular end-diastolic diameter. The predominant LBBAP capture type was left bundle fascicular capture (70%), followed by left ventricular septal capture (22%) and proximal left bundle branch capture (9%). Capture threshold and sensing were stable during a mean follow-up of 6 months. The overall complication rate was 12%.
The authors concluded that LBBAP is feasible as a primary pacing technique, but improvement in the success rate, especially in patients with heart failure, is needed.
For a few decades, (more) physiological pacing has been the holy grail of cardiac rhythm management. Direct pacing of the proximal left bundle branch pacing has been recently proposed as a more reliable method than previously advocated His-bundle pacing. LBBAP is an umbrella term which includes left bundle branch pacing, left ventricular septal pacing, and left bundle fascicular pacing. The current study shows the heterogeneity of the results with several capture types. Left bundle fascicular capture was the most common. Unfortunately, implantation failures were more likely to occur in patients who need the procedure the most—those with heart failure, enlarged left ventricle, and broad baseline QRS duration. Complications related specifically to LBBAP occurred in 8% of patients, but they were almost always septal perforations without sequelae. Based on our understanding of physiology, QRS characteristics, and a trend for lower complication rates, it seems that distal fascicular capture may be preferable. Long-term outcomes for the various types of left bundle capture are unknown and this will assuredly remain an area of intense inquiry.
Clinical Topics: Arrhythmias and Clinical EP, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Arrhythmias, Cardiac, Bradycardia, Bundle-Branch Block, Geriatrics, Heart Failure, Heart Ventricles, Outcome Assessment, Health Care, Pacemaker, Artificial
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