Long-Term Follow-Up of Left Bundle Branch Area Pacing in Pacing-Dependent Patients and Normal Cardiac Function.

Introduction: Left bundle branch area pacing (LBBAP) has emerged as a novel physiological pacing strategy. The purpose of this study was to evaluate the long-term effect of LBBAP in ventricular pacing-dependent patients and baseline normal cardiac function.

Methods: This retrospective observational study included patients who underwent LBBAP or RVP for bradycardia indications between January 2018 and July 2021. Baseline characteristics and electrophysiological, pacing and echocardiographic data were collected.

Results: Sixty patients with VP% ≥ 40% were enrolled, including 30 patients in the LBBAP group and 30 patients in the RVP group. The mean follow-up time was 53.03 ± 8.10 months in the LBBAP group and 51.87 ± 11.68 months in the RVP group. No ventricular septum perforation was observed during the procedure or follow-up. The R-wave amplitudes did not differ between the two groups at implantation, but the R-wave amplitude in the LBBAP group at last follow-up was higher than that in the RVP group (17.67 ± 7.50 mV vs. 12.38 ± 5.36 mV, p = 0.003). Paced QRS duration in the LBBAP group was significantly shorter than that in the RVP group (138.93 ± 15.36 ms vs. 164.30 ± 19.48 ms, p < 0.0001). The LBBAP group had a higher LVEF (64.81 ± 5.49 vs. 60.44 ± 9.28, p = 0.041) and lower LVESD (29.70 ± 4.59 mm vs. 32.03 ± 3.97 mm, p = 0.039) than the RVP group at last follow-up.

Conclusion: This study found LBBAP electrodes had a stable anatomic position, better pacing parameters, and better maintaining cardiac performances than RVP in patients with normal cardiac function and bradyarrhythmia indications.