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Left bundle branch area pacing: longitudinal data on pacing efficacy
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 05 – AVANÇOS NA GESTÃO DO RITMO CARDÍACO: UM OLHAR SOBRE AS INOVAÇÕES E OS RESULTADOS DO PACING
Speaker:
Joana Certo Pereira
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.1 Antibradycardia Pacing
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Joana Certo Pereira; Rita Barbosa Sousa; Daniel A. Gomes; Francisco Moscoso Costa; Gustavo Rodrigues; Daniel Matos; João Carmo; Pedro Galvão Santos; Pedro Carmo; Diogo Cavaco; Francisco Belo Morgado; Pedro Adragão
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Left bundle branch area pacing (LBBAP) has gained recognition as a technique for physiological ventricular pacing that maintains left ventricular (LV) synchrony. Although procedural characteristics are increasingly documented, information on longer terms lead stability remains scarce. We aimed to evaluate the procedural features and the stability of pacing parameters over a mid-term follow-up.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Single centre prospective study including consecutive patients undergoing LBBAP from 2021 to 2024. Data on procedural characteristics, lead parameters, and final QRS duration were gathered immediately post-implantation and <span style="color:black">throughout follow-up. Criteria for confirming conduction system capture with LBBAP was defined according to current recommendations. </span>Patients with >1 year of follow-up were invited to undergo an echocardiogram to assess follow-up left ventricular ejection fraction (LVEF).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Overall, 205 consecutive patients were included (mean age 77±12 years and 64% male). Procedural duration was 63min (IQR 51-80) and fluoroscopy time was 4.9min (IQR 2.9-7.8). Median LVAT was 86ms (IQR 78-96), paced QRS immediately after implantation was 112ms (IQR 104-120) and interpeak V1-V6 was 38ms (30-44). Acute R-wave amplitude and pacing threshold were 11.4 mV (IQR 6.9-15.7) and 0.5 mV (IQR 0.5-0.7), respectively. One case of in-hospital ischemic stroke associated with withholding anticoagulation in a patient with atrial fibrillation was reported at discharge. No other major complications were reported. Over a median follow-up of 7.9 months (IQR 2.3-15.3), both the pacing threshold (0.6 mV [IQR 0.5-0.75]) and R-wave amplitude [12.3 mV (IQR 9.0-19.3)] remained stable. QRS duration, a surrogate of LV synchrony, remained narrow: 120ms [IQR 110-122]. In the subgroup with >1 year of follow-up, 42 patients underwent LVEF assessment [median follow-up of 18 months (IQR 11-27)]. LVEF did not differ significantly from baseline (60% [IQR 40-60%] vs. 57% [IQR 48-60%], p=0.861). Ventricular pacing dependency was 60% (IQR 8–98). Notably, 6 out of 10 patients (60%) with reduced baseline LVEF showed improvement, achieving an LVEF of >40% at follow-up (mean LVEF improved from 33±5% to 50±6%, p<0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong></span></span></p> <p><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">In this cohort, LBBAP proved feasible, demonstrating excellent pacing parameters that remained stable throughout the mid-term follow-up. QRS duration did not differ during follow up and LVEF did not change significantly after 1 year of implantation, with most patients with reduced baseline LVEF showing improved ventricular function.</span></span></p>
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