Permanent left bundle branch area pacing for atrioventricular block: Feasibility, safety, and acute effect

Abstract

BACKGROUND Left bundle branch area pacing (LBBAP), a new pacing approach, lacks adequate evaluation. OBJECTIVE To assess the feasibility, safety, and acute effect of permanent LBBAP in patients with atrioventricular block (AVB). METHODS A total of 33 AVB patients with indications for ventricular pacing were recruited. Electrocardiograms, pacing parameters, echocardiographic measurements, and complications associated with LBBAP were evaluated perioperatively and at 3-month follow-up. Successful LBBAP was defined as a paced QRS morphology of right bundle branch block pattern in lead V 1 and QRS duration (QRSd) less than 130 ms. RESULTS LBBAP was successfully performed in 90.9% (30/33) of patients (mean age: 55.1 6 18.5 years; 66.7% male). The mean capture threshold was similar during the procedure (0.76 6 0.26 V at 0.4 ms) and at the 3-month follow-up (0.64 6 0.20 V at 0.4 ms). The paced QRSd was 112.8 6 10.9 ms during the procedure and 116.8 6 10.4 ms at the 3-month follow-up. Baseline left or right bundle branch block was corrected (intrinsic QRSd 153.3 6 27.8 ms vs paced QRSd 122.2 6 9.9 ms) with a success rate of 68.7% (11/16). One ventricular septal lead perforation occurred soon after the procedure with characteristics of pacing failure, and lead revision was successful. Cardiac function and left ventricular synchronization by 2-dimensional echocardiographic strain imaging at the 3month follow-up slightly improved compared with that at baseline.

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How to implant left bundle branch pacing lead in routine clinical practice

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