Document resource
Introduction Left bundle branch area pacing (LBBAP) has emerged as an effective pacing modality designed to closely replicate the heart’s natural conduction pathways. As its role continues to expand in clinical practice, it holds promise for positive short and long-term outcomes over conventional right ventricular (RV) pacing therapy. At present, data on the short and long-term outcomes is sparse as the practice is limited to selective centres in the United Kingdom. We report procedural volumes and short-term outcomes for the patients undergoing LBBAP implantation at our centre, where the service was introduced in 2023.Methods We retrospectively analysed all LBBAP procedures performed at our centre between January 2023 and February 2025. Data on demographics, indications for implantation, baseline ejection fraction, and clinical outcomes (procedural success, complications, and subsequent heart failure admissions) were collected through a review of contemporaneous patient records. Post-implant ECGs were reviewed to determine successful LBBAP, as defined by current clinical consensus.Results A total of 60 procedures were performed between three consultant operators using a combination of lumenless (78%) and stylet-driven leads (22%). The cohort had a mean age of 71 years and was predominantly male (74%). Most devices were implanted on the left side (95%) via the axillary vein approach (98.3%). AV node disease accounted for 40% of cases, followed by sick sinus syndrome (36.7%) and atrial fibrillation (23.3%), which included tachy-brady syndrome, and to facilitate AV node ablation. De novo implants comprised 72% of cases, while 28% were device upgrades.Most procedures were performed for left ventricular systolic dysfunction (LVSD) (42%), followed by a high anticipated burden of ventricular pacing (22%) and failed CRT (3.6%). Table 1 shows the pacing parameters at implantation and follow-up. The average left ventricular activation time (LVAT), final paced QRS duration, DAP dose, fluoroscopy and procedural times are summarized in figure 1. During the post-implant follow up period, 11.7% of patients required heart failure hospitalisation. To date, no patients have required revision of the LBBAP lead.Conclusion The adoption of LBBAP is steadily growing and our experience suggests that, after overcoming the initial learning curve, it demonstrates physiological pacing with consistently low and stable pacing thresholds during long term follow up. In our cohort of patients, the success rates are high, with minimal procedural complications reported to date. Moving forward, we will continue to audit our local practice and make improvements to ensure optimal outcomes for our patients.Abstract 4-020 Table 1Average of pacing parameters at implant and follow-up periods Pacing parameters Implant 6 weeks 6 months 12 months Sensing (R wave) 10.2 (3.1–25) 10.6 (2.8- >20) 11.0 (4.3- >20) 12.5 (4.6- >20) Threshold (@0.4–0.5ms) 0.9 (0.4–3.2) 0.7 (0.375–2.5) 0.8 (0.5–2.5) 0.7 (0.5–1) Impedance (ohms) 823 (466–1600) 481 (312–836) 429 (342–741) 355 (304–380) Abstract 4-020 Figure 1Average of procedure metrics summary