Feasibility and safety of left bundle branch area pacing invery elderly patients (≥80 years).

Abstract

Left bundle branch area pacing (LBBAP) has emerged as a promising physiologic pacing strategy. Though many clinical studies have established the feasibility and safety of LBBAP, the data for very elderly patients are lacking. This study aimed to assess the feasibility and safety of LBBAP in very elderly patients (≥80 years). Two hundred and forty consecutive patients who received LBBAP implantation were retrospectively enrolled in the present study. Inclusion criteria were patients with atrioventricular block, atrial fibrillation with a slow ventricular response, and heart failure with bundle branch block. The patients were divided into two groups: those aged ≥80 years and those aged <80 years. LBBAP implantation was successfully performed in 48 of 53 (90.6%) very elderly patients and 162 of 187 (86.5%) counterparts. In the very elderly group, the mean (standard deviation [SD]) age was 84 (3) years, mean (SD) paced QRS duration was 112.4 (9.0), and the mean (SD) stimulus to R wave peak time was 82.0 (14.2) ms. Mean (SD) pacing thresholds and mean (SD) R wave sensing were 0.61(0.21) V and 12.1 (4.7) mV at implant. Pacing parameters in very elderly patients were similar to those in their counterparts. During a median follow-up of 6 months, pacing parameters remained stable. Five patients in the very elderly group developed complications (1 with septal perforation during the procedure, 1 with pocket hematoma, 1 with pacing threshold increase, and 2 with micro lead dislodgement during follow-up). LBBAP is safe and effective in patients ≥80 years old. LBBAP can be considered as an alternative method for delivering physiological pacing in this special population.