Key result
LBBAP is preferred over His-bundle pacing first-line by surveyed European physicians, with ~77% experienced in both.
Why the study?
The field of conduction system pacing is evolving, and the study aimed to obtain a contemporary picture of European clinical practice.
Cross-Sectional (n=171)
Yes
A European survey indicates that left bundle branch area pacing is preferred over His-bundle pacing for bradycardia indications, while conventional biventricular pacing remains first-line for heart failure with LBBB.
Survey data on European pacing preferences should not yet guide practice; leaves open need for outcome trials comparing LBBAP and HBP.
AIMS: The field of conduction system pacing (CSP) is evolving, and our aim was to obtain a contemporary picture of European CSP practice. METHODS AND RESULTS: A survey was devised by a European CSP Expert Group and sent electronically to cardiologists utilizing CSP. A total of 284 physicians were invited to contribute of which 171 physicians (60.2%; 85% electrophysiologists) responded. Most (77%) had experience with both His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP). Pacing indications ranked highest for CSP were atrioventricular block (irrespective of left ventricular ejection fraction) and when coronary sinus lead implantation failed. For patients with left bundle branch block (LBBB) and heart failure (HF), conventional biventricular pacing remained first-line treatment. For most indications, operators preferred LBBAP over HBP as a first-line approach. When HBP was attempted as an initial approach, reasons reported for transitioning to utilizing LBBAP were: (i) high threshold (reported as >2 V at 1 ms), (ii) failure to reverse bundle branch block, or (iii) > 30 min attempting to implant at His-bundle sites. Backup right ventricular lead use for HBP was low (median 20%) and predominated in pace-and-ablate scenarios. Twelve-lead electrocardiogram assessment was deemed highly important during follow-up. This, coupled with limitations from current capture management algorithms, limits remote monitoring for CSP patients. CONCLUSIONS: This survey provides a snapshot of CSP implementation in Europe. Currently, CSP is predominantly used for bradycardia indications. For HF patients with LBBB, most operators reserve CSP for biventricular implant failures. Left bundle branch area pacing ostensibly has practical advantages over HBP and is therefore preferred by many operators. Practical limitations remain, and large randomized clinical trial data are currently lacking.
No takes yet. Share an insight, caveat, or question.
Keene et al. (2023) conducted a cross-sectional in Conduction system pacing practice (n=171). Survey on conduction system pacing was evaluated on Contemporary picture of European CSP practice. A survey of 171 European physicians showed that 77% had experience with both His-bundle and left bundle branch area pacing, with the latter preferred as a first-line approach for most indications.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: