Left bundle branch area pacing: predictors of success. (19th May 2022)

• Record Type: Journal Article
• Authors: Estevez Paniagua, A; Briongos Figuero, S; Sanchez Hernandez, A; Munoz Aguilera, R
• Is Part Of: Europace. Volume 24:Supplement 1(2022)
• Publication Date: 2022-05-19
• Subjects: Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euac053.440
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Funding Acknowledgements: Type of funding sources: None. Background: Frequent conventional pacing of the right ventricle can be deleterious. In the last three years, left bundle branch area pacing (LBBAP) has experienced a great development as a tool for the specific conduction system stimulation. Methods: Single-center prospective study of consecutive patients with attempted LBBAP for bradycardia or heart failure indications (bailed-out strategy). A 3830-69 lead was implanted using a C-315-His sheath, and we aimed for left bundle branch pacing (LBBP) in all patients. Current criteria to define LBAPP, LBBP (selective or non-selective), and left ventricle septal pacing (LVSP) were used. The goal of our study was to analyze clinical, electrical, and echocardiographic variables that may predict the achievement of LBBP. Results: We included 149 patients between Feb/20 and Jan/22. Baseline characteristics and pacing indications are shown in table 1. We had success in 145 patients (97.3%): 78.9% were considered LBBP (44.4% SLBBP), and 21.1% LVSP. Paced QRS was significantly higher in patients with wide basal QRS (120.9 ± 15.2 ms vs 110.7 ± 12.6 ms, p<0.001). Likewise, left ventricular activation time (LVAT) in V5/V6 and aVL was shorter in the group with narrow basal QRS (77.2 ± 10.5 vs 83.3 ± 11.4, p<0.001, and 80.0 ± 14.1 vs 87.6 ± 14.4, p <0.001, respectively), being much more frequent to achieve an LVAT <80 ms in the group with narrow QRS (64.9% vs 42.2%, OR 2.6, p = 0.004). Logically, the variation of the paced QRS compared to baseline was also different in both groups (-25.4 ± 12.5 ms in the wide QRS group and + 16.2 ± 13.8 ms in the narrow QRS group). LBBP was achieved to a greater extent in the narrow QRS group (89.2% vs 67.6%, OR 3.9, p=0.002); the difference between selective and non-selective LBBP based on baseline QRS was not significant. Regarding the clinical variables, the presence of hypertension, diabetes mellitus, heart failure or COPD did not show a significant difference in the achievement of LBBP. In contrast, it was significantly less frequent to achieve LBBP in patients with LV systolic dysfunction of any degree (62.0% vs 83.2%, p=0.02), or chronic ischemic heart disease (61.1% vs 82.1%, p=0.04), with a trend in patients with CKD (67.7% vs 82.6%, p=0.06). Also, the bradycardia pacing indication had a significant influence, with the percentage of LBBP being lower in patients with atrioventricular conduction system disease compared to sick sinus syndrome (72.0% vs 85.1%, p=0.04). On the other hand, there was no significant association between the achievement of LBBP and echocardiographic parameters such as interventricular septum thickness, and left atrial volumen. Conclusions: LBBAP as elective ventricular pacing is feasible, with a high success rate, and in most cases, it is possible to capture the conduction system. However, there appear to be factors that a priori may pose a greater challenge in its achievement, highlighting the electrical conduction system and myocardial disease.