Mid-term clinical outcomes of left bundle branch area pacing compared to accurate right ventricular septal pacing

Yousaku Okubo; Takumi Sakai; Shogo Miyamoto; Yukimi Uotani; Naoto Oguri; Motoki Furutani; Shunsuke Miyauchi; Sho Okamura; Takehito Tokuyama; Yukiko Nakano

doi:10.1007/s10840-024-01890-z

Mid-term clinical outcomes of left bundle branch area pacing compared to accurate right ventricular septal pacing

J Interv Card Electrophysiol. 2024 Jul 29. doi: 10.1007/s10840-024-01890-z. Online ahead of print.

Authors

Affiliations

¹ Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan. yousaku4039@gmail.com.
² Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.

PMID: 39073704
DOI: 10.1007/s10840-024-01890-z

Abstract

Background: Although left bundle branch area pacing (LBBAP) reportedly results in fewer adverse outcomes after implantation than conventional stylet-guided right ventricular septal pacing (RVSP), previous studies have not compared LBBAP with accurate RVSP using a delivery catheter. The aim of this study was to compare clinical outcomes between LBBAP and accurate RVSP among patients with atrioventricular block (AVB).

Methods: This single-center observational study enrolled 160 patients requiring RV pacing due to symptomatic AVB between September 2018 and December 2021. Primary composite outcomes included all-cause death, hospitalization due to heart failure (HF), and upgrading to biventricular pacing. Secondary composite outcomes included any procedural and postprocedural complications.

Results: Overall, 160 patients were analyzed (LBBAP, n = 81; RVSP, n = 79). No significant differences in baseline characteristics were observed between the two groups. The RV pacing burden at 1 year after implantation was 90.8% ± 20.4% and 86.2% ± 22.6%, respectively (p = 0.21). During a mean follow-up of 840 ± 369 days, the incidence of the primary outcome was significantly lower with LBBAP (4.9%) compared to RVSP (22.8%) (Log-rank p = 0.02). There was no significant difference in the incidence of the secondary outcome between the two groups (3.7% vs. 5.1%, p = 0.65). In the multivariate analysis, baseline QRS duration, RV pacing burden, and LBBAP were independently associated with the primary outcome (baseline QRS duration: hazard ratio [HR], 1.01; 95% confidence interval [CI], 1.00-1.02; p < 0.001; RV pacing burden: HR, 1.01; 95% CI, 1.00-1.02; p < 0.001; LBBAP: HR, 0.45; 95% CI, 0.31-0.64; p < 0.001).

Conclusion: In patients requiring frequent RV pacing, LBBAP was associated with reduced adverse clinical outcome compared to accurate RVSP using a delivery catheter.

Keywords: Atrioventricular block; Conduction system pacing; Delivery catheter; Left bundle branch area pacing; Right ventricular septal pacing.