Worldwide survey on implantation of and outcomes for conduction system pacing with His bundle and left bundle branch area pacing leads

Abstract

Background Adoption and outcomes for conduction system pacing (CSP), which includes His bundle pacing (HBP) or left bundle branch area pacing (LBBAP), in real-world settings are incompletely understood. We sought to describe real-world adoption of CSP lead implantation and subsequent outcomes. Methods We performed an online cross-sectional survey on the implantation and outcomes associated with CSP, between November 15, 2020, and February 15, 2021. We described survey responses and reported HBP and LBBAP outcomes for bradycardia pacing and cardiac resynchronization CRT indications, separately. Results The analysis cohort included 140 institutions, located on 5 continents, who contributed data to the worldwide survey on CSP. Of these, 127 institutions (90.7%) reported experience implanting CSP leads. CSP and overall device implantation volumes were reported by 84 institutions. In 2019, the median proportion of device implants with CSP, HBP, and/or LBBAP leads attempted were 4.4% (interquartile range [IQR], 1.9-12.5%; range, 0.4-100%), 3.3% (IQR, 1.3-7.1%; range, 0.2-87.0%), and 2.5% (IQR, 0.5-24.0%; range, 0.1-55.6%), respectively. For bradycardia pacing indications, HBP leads, as compared to LBBAP leads, had higher reported implant threshold (median [

Real-World Performance of Conduction System Pacing Compared With Traditional Pacing

“… 2 Conduction system pacing including His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) has emerged as an alternative pacing strategy to prevent or mitigate systolic heart failure. 3 The purpose of our study was to compare the performance of leads in RV, HB, and LBBA positions in a real-world cohort.…”

His Bundle Pacing: Predicting Mortality and Major Complications in Mid-Term Follow-Up

“…Conduction system pacing (CSP), including His bundle pacing (HBP), is an emerging technique for preventing pacing-related adverse effects [ 4 ] and is included in European Society of Cardiology guidelines on cardiac pacing and cardiac resynchronization therapy (CRT) [ 5 ]. CSP, initially preferred, is considered safe and suitable in most patients with an indication for pacemaker implantation [ 2 , 6 ]; however, it still has not become the first-choice method of pacing [ 7 ]. Studies confirmed HBP’s feasibility, favorable safety profile, and clinical benefits compared with RVP [ 1 , 2 , 8 , 9 ].…”

Comparison of Depolarization and Repolarization Parameters in Left vs. Right Ventricular Septal Pacing—An Intraprocedural Electrocardiographic Study

“…Two cardiac pacing techniques have been implemented in routine clinical practice with the aim of capturing either the His bundle or the left bundle branch and, consequently, using the intrinsic conduction system for ventricular electrical activation. Left bundle branch area pacing (LBBAP) has gradually become the preferred option for physiological pacing in many laboratories due to a wider target area and better pacing and sensing thresholds compared with His bundle pacing [ 2 ]. Moreover, compared with conventional RVP, several studies have shown a net clinical benefit of LBBAP in terms of ejection fraction preservation and reduced hospitalizations for heart failure [ 3 ].…”