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Mid-term feasibility, safety and outcomes of left bundle branch pacing–single center experience

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Abstract

Background

His bundle pacing (HBP) has evolved as the most physiological form of pacing but associated with limitations. Recently, left bundle branch pacing (LBBP) is emerging as an effective alternative strategy for HBP.

Objectives

Our study was designed to assess the feasibility, efficacy, electrophysiological parameters, and mid-term outcomes of LBBP in Indian population.

Methods

All patients requiring permanent pacemaker implantation for symptomatic bradycardia and heart failure were prospectively enrolled. Echocardiography, QRS duration, pacing parameters, left bundle (LB) potentials, paced QRS duration, and peak left ventricular activation time (pLVAT) were recorded.

Results

LBBP was successful in 93 out of 99 patients (94% acute success). Mean age was 62.6 ± 13 years, male 59%, diabetes 69%, and coronary artery disease 65%. Follow-up duration was 4.8 months (range1–12 months). Indication for pacing included atrioventricular (AV) block 43%, cardiac resynchronization therapy 44%, and AV node ablation 4%. LB potential was noted in 37 patients (40%). QRS duration reduced from 144.38 ± 34.6 at baseline to 110.8 ± 12.4 ms after LBBP (p < 0.0001). Pacing threshold was 0.59 ± 0.22 V and sensed R wave 14.14 ± 7.19 mV, and it remained stable during follow-up. Lead depth in the septum was 9.62 mm. LV ejection fraction increased from 44.96 to 53.3% after LBBP (p < 0.0001). One died due to respiratory tract infection on follow up.

Conclusion

LBBP is a safe and effective strategy (94% acute success) of physiological pacing. The pacing parameters remained stable over a period of 12 months follow-up. LBBP can effectively overcome the limitations of HBP.

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Authors and Affiliations

  1. Department of Cardiology, Velammal Medical College Hospital and Research Institute, Velammal Village, Airport ring road, Madurai, Tamilnadu, 625009, India

    Shunmuga Sundaram Ponnusamy, Giridhar Muthu, Mahesh Kumar, Dasarath Bopanna, Vijesh Anand & Surya Kumar

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  1. Shunmuga Sundaram Ponnusamy
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  2. Giridhar Muthu
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  3. Mahesh Kumar
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  4. Dasarath Bopanna
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  5. Vijesh Anand
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  6. Surya Kumar
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Corresponding author

Correspondence to Shunmuga Sundaram Ponnusamy.

Ethics declarations

The study was conducted after getting the ethical committee approval. The paper is not under consideration elsewhere. None of the paper’s contents have been previously published. All authors have read and approved the manuscript.

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Highlights of the study

1. Data for left bundle branch pacing for south Asian population is unknown.

2. LBB pacing was successful in 94% of pacing indicated Indian population (93 out of 99 patients).

3. Low and stable threshold remained constant throughout the study period.

4. AV block was the indication in 43% (n = 40) and Sinus node dysfunction in 9% (n = 8). LBBP was successful in 91% of patients with AV block (40 out of 44 attempted patients).

5. Effective reduction in QRS duration from 144 before pacing to 110 ms after LBB pacing though QRS reduction alone may not confer clinical benefit.

6. Significant improvement in LV ejection fraction from 44 to 53% along with non-significant reduction in LV end-diastolic diameter (53.1 to 51.1 mm).

7. Cardiac resynchronization therapy could be achieved in 41 out of 43 attempted patients resulting in significant reduction in QRS duration and improvement in LV ejection fraction.

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Ponnusamy, S.S., Muthu, G., Kumar, M. et al. Mid-term feasibility, safety and outcomes of left bundle branch pacing–single center experience. J Interv Card Electrophysiol 60, 337–346 (2021). https://doi.org/10.1007/s10840-020-00807-w

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