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01. History of Cardiology
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04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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32. Cardiovascular Nursing
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Left Bundle Branch Area Pacing as a Physiologic Alternative to Right Ventricular Conventional Pacing in Permanent Atrial Fibrillation
Session:
Sessão de Posters 01 - Estimulação do sistema de condução: LBBAP na prática
Speaker:
Tatiana Pereira Dos Santos
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.1 Antibradycardia Pacing
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Tatiana Pereira dos Santos; Ana L. Silva; Didier Martinez; Maria João Primo; Inês Brito e Cruz; Mariana Simões; Luísa Gomes Rocha; Carolina Saleiro; Patrícia Alves; João André Ferreira; Natália António; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Background: Left bundle branch area pacing (LBBAP) is an emerging physiological pacing strategy associated with better clinical outcomes than conventional right ventricular (RV) pacing. Evidence in patients with permanent atrial fibrillation (AF), however, remains limited. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Methods: This single-center retrospective study included patients who underwent LBBAP between September 2022 and June 2024. Baseline pacing indication, procedural characteristics, and LVEF were collected. The primary endpoint was a composite of emergency visits for acute heart failure (HF) and HF hospitalization. We compared outcomes between LBBAP and conventional RV pacing in patients with permanent AF. Median follow-up was 873 days (IQR 355.5). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Results: The analysis included 165 patients with permanent atrial fibrillation who underwent pacemaker implantation (72.1% male; mean age 81.9±0.56 years). Of these, 46 (27.9%) received LBBAP and 119 (72.1%) RV pacing. Baseline cardiovascular risk factors were similar between groups. Pacing indications were complete heart block in 58 patients (35.2%) and bradycardia in 106 (64.2%), with one case (0.6%) of alternating bundle branch block. Median left ventricular ejection fraction (LVEF) for the entire cohort was 57% (IQR = 11.5). The LBBAP group had a slightly lower baseline LVEF, with a median of 55% (IQR = 10), which was statistically significant (p = 0.044). Procedure duration was similar between groups (p>0.05) with a mean of 57.59±2,54 min. The mean intrinsic QRS duration for the entire cohort was 129.3 ± 2.37ms. Among paced complexes, LBBAP produced a narrower QRS (122.0 ± 3.0ms) compared with RV pacing (159.9 ± 2.39ms, p < 0.001). Capture thresholds (0.53 V) and sensed R-wave amplitudes (12.86 mV) were similar between groups. Median ventricular pacing during follow-up was 79.5%, with no difference by pacing modality (p = 0.372). In Cox regression adjusted for confounders, RV pacing was associated with a 4.02-fold higher risk of heart failure events versus LBBAP (HR 4.02, 95% CI 1.1–14.5, p = 0.033).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Conclusion: In patients with permanent atrial fibrillation, LBBAP was feasible, achieved pacing parameters comparable to RV pacing, and produced narrower paced QRS complexes. LBBAP was associated with fewer adverse clinical outcomes, while RV pacing conveyed a 4-fold higher risk of heart failure events. These results support LBBAP as a more physiological and clinically favorable pacing strategy in this population.</span></span></p>
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