INTERMEDIATE TERM PERFORMANCE AND SAFETY OF LEFT BUNDLE BRANCH AREA CONDUCTION SYSTEM PACING LEADS: A MULTICENTER PROSPECTIVE STUDY

Abstract

<h3>BACKGROUND</h3> Left bundle branch area pacing (LBBAP) has shown to be a reliable alternative to His bundle pacing (HBP) for physiologic pacing. There are limited data on the intermediate term performance of LBBA pacing leads. Objective: To evaluate the intermediate term performance and safety of LBBAP. <h3>METHODS AND RESULTS</h3> Patients referred for pacemaker implantation at two academic centers between 02/2019 - 1/2021 were considered for LBBAP. LBBAP was performed by implanting the 3830 lumenless lead using the C315 fixed curve or C304 His deflectable sheath (Medtronic, MN). Implant success rates, complications and electrophysiological parameters were assessed. LBBAP was successful in 566/619 patients (91%). Mean age was 73±12 yrs, 46% were women. 37% had QRSd >130 ms, 25% RBBB, 11% LBBB, 4% IVCD. Pacing indications include sinus node dysfunction in 27%, AV block 56%, CRT 7% and refractory AF 10%. Mean procedural duration was 73±32 mins (median 70 mins) and fluoroscopic time was 10±7 mins (median 8 mins). Baseline QRSd was 119±31ms vs paced QRSd was 113±12ms (p < 0.001). Mean LV activation time was 73±12ms at high output and 76±12ms at low output. LBB potentials were noted in 175 (31%) patients. Transition from non-selective to selective LBBA or septal pacing was noted in 393 (74%). Pacing threshold and R waves were 0.74±0.3V@0.4ms and 11±5mV at implant and 0.83±0.2V@0.4ms and 15± 5mV at a mean follow-up of 167±172 days (range 25-662 days) (Fig). The only complication was LBBAP lead dislodgement in 6 (1%) patients occurring within 24-72 hours. <h3>CONCLUSION</h3> LBBA pacing is safe and feasible with high success rates and low complication rates during intermediate term follow-up.