Left bundle branch area pacing is a physiological alternative to the right ventricular/biventricular pacing - the results of implantation center registry
Abstract
Left bundle branch area pacing (LBBAP) is a new method of pacing in patients who have bradycardia or are indicated to receive cardiac resynchronization therapy (CRT). Data on intraoperative and postoperative outcomes of this method are lacking.
Methods: All patients with bradycardia or an indication for CRT, who underwent LBBAP during a surgical procedure at the Heart Centre of the Kralovske Vinohrady University Hospital and the Third Faculty of Medicine of Charles University in the period from 11/2018 to 05/2021, were included in the registry. Most patients were included in the registry in a prospective manner, and selected parameters were added retrospectively.
To obtain basic clinical, intraoperative, and postoperative parameters, data from the electronic hospital information system and the electrophysiological device employed during the course of surgical procedures were used. Results: LBBAP was performed in 329 patients, of which 237 had bradycardia and 92 were indicated to receive CRT.
The pacing thresholds for achieving LBBAP were 0.6 +- 0.5 V per 0.5 ms on average, and were stable with a mean follow-up duration of 5 +- 5 months (0.7 +- 0.3 V per 0.4 ms). Complications were seen in 26 patients (8%), of which 15 were specific complications related to LBBAP (12 cases of intraoperative lead penetration into the right ventricle, 1 case of chest pain, and 1 case of chest pain with ST segment elevation after lead placement) which, however, resolved without sequelae during the course of the procedure.
The overall success rate of LBBAP was 89% and was significantly higher in patients with bradycardia than in those indicated to receive CRT (92% vs 83%, p = 0.02). A significant effect of the number of procedures performed on the success rate of LBBAP and the rate of some complications was observed.
Conclusion: LBBAP is a possible alternative to permanent cardiac pacing in patients who have bradycardia or are indicated to receive CRT. It is associated with certain specific complications, whose significance requires evaluation in terms of the method's benefit in randomized trials. (C) 2022 SOLEN s.r.o..
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