Nationwide trends in left bundle branch area pacing in South Korea

Background/Introduction Left bundle branch area pacing (LBBAP) is a physiological alternative to conventional right ventricular pacing (RVP), but its national implantation trend in Asia remains unclear. Purpose To describe temporal, demographic, and regional trends in LBBAP use among patients undergoing de novo permanent pacemaker (PPM) implantation in South Korea. Methods We analyzed a nationwide health insurance claims database and identified 19,372 patients who underwent de novo PPM implantation between 2020 Q4 and 2023 Q4. LBBAP and RVP were classified using procedure and device codes. Baseline characteristics, pacing indications, and comorbidities were compared between LBBAP (n = 2,096) and RVP (n = 17,276). Quarterly LBBAP implantation rates were evaluated overall and stratified by bradycardia type, age group, geographic region, and hospital type. Results Overall, 10.8% of implants used LBBAP. Compared with RVP recipients, LBBAP patients were younger (72.3 ± 12.3 vs. 75.1 ± 10.4 years) and more often male (52.1% vs. 44.2%), with a higher prevalence of atrioventricular block (75.8% vs. 50.9%) and lower rates of sinus node dysfunction (13.5% vs. 41.9%) and atrial fibrillation. The proportion of LBBAP increased from 0.8% in 2020 Q4 to 16.3% in 2023 Q4, reaching 23.4% among atrioventricular block cases. LBBAP use was higher in younger patients (25.9% in 20–49 years vs. 9.2% in ≥80 years) and in tertiary hospitals (14.6% vs. 5.5% in secondary hospitals). Marked regional heterogeneity was observed, with LBBAP ratios of 18.8% in Seoul, 13.2% in urban centers, and 7.1% in suburban/rural regions. Conclusion In South Korea, LBBAP adoption has increased rapidly and now accounts for approximately one in six de novo PPM implants, particularly in younger patients with atrioventricular block and in tertiary metropolitan centers. These findings demonstrate a nationwide shift toward physiological pacing and highlight substantial regional variation that may inform guideline implementation, training, and resource allocation.