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The reported success rates of His bundle pacing (HBP) in patients with AV nodal disease is over 90% and in infra nodal disease is only about 50-75%. The success rates of left bundle branch area pacing (LBBAP) in this cohort is not well studied.
Objective
To evaluate the feasibility and safety of LBBAP in patients with AV nodal and infra nodal disease.
Methods
Patients with AV block at nodal and infra nodal level (Mobitz I/II, advanced AV block and complete heart block) referred for pacemaker implantation at two centers between 02/2019-1/2021 were considered for LBBAP using 3830 lumenless lead. Implant success rates and electrophysiological parameters were assessed.
Results
LBBAP was successful in 321/346 (93%) patients (93% AV nodal; 92% infra nodal). The baseline demographics, procedural characteristics in patients with AV nodal vs infra nodal disease is shown in table. There was no difference in the mean procedural duration and fluoroscopic duration in both groups. Baseline QRSd and paced QRSd was significantly narrower in the AV nodal group compared with infra-nodal AV block group (Figure). Mean LV activation times were short and constant and not different between the groups. LBB potentials were noted in 35% of patients in each group. Pacing threshold and R waves were 0.77±[email protected] and 11±5mV at implant and 0.79±[email protected] and 16±5mV at a mean follow-up of 167±172 days (range 25-662 days).
Conclusion
LBBA pacing is safe and feasible with high success rates in patients with AV block irrespective of nodal or infra nodal level of block.
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