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Left Bundle Branch Area Pacing in Patients with Atrioventricular Conduction Disease: A Prospective Multicenter Study.

Authors:
Alexandre Raymond-Paquin Atul Verma Jeffrey Kolominsky Paula Sanchez-Somonte Elvin Gul Ajay Pillai Jordana Kron Richard Shepard Gautham Kalahasty Bernice Tsang Yaariv Khaykin Alfredo Pantano Jayanthi N Koneru Kenneth A Ellenbogen

Heart Rhythm 2022 May 10. Epub 2022 May 10.

Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.

Background: The reported success rate of His bundle pacing (HBP) in patients with infranodal atrioventricular (AV) conduction disease is only 52-76%. The success rate of left bundle branch area pacing (LBBAP) in this cohort is not well studied.

Objective: To evaluate the feasibility, safety, and electrophysiological characteristics of LBBAP in patients with AV conduction disease.

Methods: Patients with AV conduction disease referred for pacemaker implantation at two centers between 02/2019 and 6/2021 were considered for LBBAP. Baseline demographic characteristics, procedural success rates, electrophysiological parameters and complications were assessed.

Results: LBBAP was successful in 340/364 (93%) patients. Mean age was 72±13 years and mean follow-up was 331±244 days. Pacing indications were Mobitz I in 27 patients (7%), Mobitz II or 2:1 AV block or high-grade AV block in 94 patients (26%), complete heart block in 199 patients (55%) and sick sinus syndrome with isolated bundle branch block in 44 patients (12%). LBBB and RBBB were present in 57 patients (16%) and 140 patients (38%) respectively. Procedural success rates did not differ between indications (92.6%, 93.6%, 92.9% and 95% respectively) or between patients with narrow (<120ms) versus wide QRS (≥120ms). Mean LBBAP threshold was 0.77±0.34V at 0.4ms at implant and remained stable during follow-up. There were 4 (1.2%) acute LBBAP lead dislodgements.

Conclusions: LBBAP is safe and feasible with high success rates for patients with AV conduction disease. Contrary to HBP, LBBAP success rates remain high over the entire spectrum of AV conduction disease and lead parameters remain stable during follow-up.

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http://dx.doi.org/10.1016/j.hrthm.2022.04.033DOI Listing
May 2022

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