Left bundle branch area pacing maintained stable lead parameters at 11 months and improved LVEF to >40% in 62% of patients with baseline LVEF <40% (P=0.001).
Observational (n=298)
No
Does Left bundle branch area pacing (LBBAP) maintain stable pacing parameters and preserve left ventricular function at long-term follow-up?
Left bundle branch area pacing demonstrates stable long-term electrical parameters and preserves or improves left ventricular ejection fraction, particularly in patients with baseline reduced LVEF.
Abstract Introduction Left bundle branch area pacing (LBBAP) is increasingly recognized as a physiological pacing technique that preserves left ventricular (LV) synchrony. This study aims to evaluate long-term stability of pacing, electrocardiographic, and echocardiographic parameters. Methods Single center retrospective study including consecutive patients who underwent LBBAP between 2021 and 2025. LBBAP criteria was defined as a right bundle branch block pattern in lead V1 and LV activation time (LVAT) of 90ms. Data on lead performance and electrocardiographic and echocardiographic parameters were obtained at implantation and at the final follow-up visit. Results A total of 298 patients were included median age 79 (IQR 71-84) years, 66% (n=197) male. The most common indications were atrioventricular (AV) node disease (59%, n=176), sinus node disease (18%, n=53) and biventricular cardiac resynchronization therapy (CRT) bailout (11%, n=32). Nineteen patients (6%) had undergone transcatheter aortic valve implantation prior to LBBAP implantation. Procedural duration was 63 (IQR 50-80) minutes, with a fluoroscopy time of 5 (IQR 3-8) minutes. Median LVAT was 86 ms (IQR 76–93), paced QRS duration was 111 ms (IQR 100–120), and the interpeak V1–V6 interval was 38 ms (IQR 29–45). The acute R-wave amplitude reached 11.8 mV (IQR 7.4–16.6), and the pacing threshold was 0.5 V (IQR 0.5–0.7). At a median follow-up of 11 months (IQR 5–22), lead parameters remained stable, with a pacing threshold of 0.6 V (IQR 0.5–0.8) and an R-wave amplitude of 12.2 mV (IQR 9.2–20.0). The paced QRS duration remained narrow at 120 ms (IQR 110–126). Only five procedure-related complications were reported: two cases of device-associated endocarditis, two cases of lead dislodgement, and one case of pericarditis. In the subgroup of patients who underwent left ventricular ejection fraction (LVEF) assessment at 1-year follow-up (n=104), LVEF was preserved 60% (IQR 44–60) vs. 55% (IQR 50–60); p=0.485, with a ventricular pacing dependency of 95% (IQR 32–100) at follow-up. Among the 21 patients with a baseline LVEF40%, most received LBBAP as a bailout CRT strategy, and 13 (62%) demonstrated an improvement in LVEF40% at follow-up median LVEF 32% (IQR 26-35) vs 42% (35-50), p=0.001. Conclusion At a median follow-up of 11 months, lead parameters were stable and QRS duration was narrow. In the subgroup of patients who underwent echocardiographic evaluation at 1-year follow-up, LVEF was preserved. Moreover, 62% of patients with previously reduced LVEF demonstrated improvement in LVEF.
Sousa et al. (Mon,) conducted a observational in Atrioventricular node disease, sinus node disease, and biventricular CRT bailout (n=298). Left bundle branch area pacing (LBBAP) was evaluated on Long-term stability of pacing, electrocardiographic, and echocardiographic parameters. Left bundle branch area pacing maintained stable lead parameters at 11 months and improved LVEF to >40% in 62% of patients with baseline LVEF <40% (P=0.001).