Comparative analysis of His-bundle pacing and left bundle branch area pacing: acute and short-term results

Introduction: His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP) are novel techniques that have demonstrated their efficacy in patients needing right ventricular pacing and in candidates for resynchronization therapy. The purpose of this study was to compare acute and short-term outcomes between HBP and LBBAP. Methods: Retrospective review of the success rate and change in QRS duration obtained by HBP and LBBAP in patients requiring anti-bradycardia pacing or cardiac resynchronization, evaluating the complications and pacing parameters at implantation and at 3 months. Results. The study included 90 procedures (46 HBP and 44 LBBAP) in 87 patients. Success was achieved in 77 procedures (85.6%): 37 (80.4%) in the HBP group and 40 (90.9%) in the LBBAP group (P = .23). Paced QRS duration was shorter in the LBBAP patients (109 ± 8 vs. 117 ± 19 ms; P < .05), who had a lower threshold during implantation (0.5 V/0.5 ms vs. 1.5 V/1 ms; P < .001) and at 3 months (0.72 V/0.5 ms vs. 1.75 V/1 ms; P < .001) and an increased sensed R-wave amplitude. The fluoroscopy time was shorter in the LBBAP group (10 vs. 19 minutes; P < .001). The complication rate was similar (6.8% vs. 12.8%; P = .48). Conclusion. In our experience, LBBAP obtains a similar success rate to that of HBP and achieves a shorter paced QRS duration, greater R-wave detection, lower threshold, and shorter fluoroscopy time, with a similar complication rate.