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Long-term clinical outcomes of left bundle branch area pacing among elderly patients
Session:
Sessão de Posters 01 - Estimulação do sistema de condução: LBBAP na prática
Speaker:
Mariana Rodrigues Simões
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:
Mariana Rodrigues Simões; Luísa Gomes Rocha; Ana Luísa Silva; Tatiana Pereira dos Santos; Diogo Fernandes; Carolina Saleiro; João Ferreira; Natália António; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif">Introduction: </span></span></span><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif">Left bundle branch area pacing (LBBAP) </span><span style="font-family:"Arial",sans-serif">has emerged as a physiologic alternative to right ventricular pacing (RVP), reducing desynchrony that can lead to pacing-induced cardiomyopathy. As elderly patients are especially susceptible to heart failure, LBBAP can offer additional protection in this high-risk population. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif">Methods: We conducted a single-centre retrospective, observational study including patients </span></span></span><em><span style="font-size:12.0pt"><span style="font-family:"Cambria Math",serif">≥ </span></span></em><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif">75 years </span><span style="font-family:"Arial",sans-serif">who underwent cardiac implantable electronic devices implantation between September 2022 and September 2025. The objective was to compare </span><span style="font-family:"Arial",sans-serif">LBBAP with RVP, in patients with implanted pacemakers, regarding Emergency Department (ED) admissions due to heart failure (HF), hospitalization for HF, and all-cause mortality. Statistical analysis was performed using SPSS. Categorical variables were compared with chi-square test, and continuous variables with the Student’s T-test or the Wilcoxon test, as appropriate. Hazard ratios for outcome predictors were estimated using Cox regression.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif">Results: A total of 1174 patients were included, of whom 726 were men and 448 were women. The mean age was 83.09</span><span style="font-family:"Arial",sans-serif">± 5.02 years, and the median follow-up time was 679 (IQR 633) months. Of these patients, 372 patients underwent LBBAP and 784 received RVP. No significant differences were observed between the groups regarding past medical history, such as hypertension (LBBAP: n= 139 vs RVP: n=327, p=0.342), coronary artery disease (LBBAP: n= 27 vs RVP: n= 52, p=0.464) or diabetes <em>mellitus </em>(LBBAP: n= 66 vs RVP: n= 137, p=0.478). The LBBAP group had a significantly lower median left ventricular ejection fraction (LVEF) compared with the RVP group: 55% (IQR 12.75)<em> vs</em> 57% (IQR 5), p<0.001. The LBBAP group also had a higher median pacing percentage: 94.65% (IQR 67.75) <em>vs </em>76% (IQR 85.5), p<0.001. For hospitalization due to HF, 14 patients in the LBBAP group<em> </em>and 75 patients in the RVP group were hospitalized; however, the difference was not statistically significant (HR 0.743, 95% CI 0.357-1.548; p=0.415). Regarding all-cause mortality, although fewer death occurred in the LBBAP group (n=26 <em>vs</em> n=106), the difference was not significant (HR 0.929, 95% CI 0.599-1.439; p=0.739). The LBBAP group had significantly fewer ED admissions for HF (n=14 <em>vs </em>n=75; </span><span style="font-family:Symbol">b</span><span style="font-family:"Arial",sans-serif">= -0.626, HR 0.535, 95% CI 0.302-0.948; p=0.022) (Figure 1). </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif">Conclusion: Among older patients, LBBAP seems to reduce ED admissions for heart failure compared with right ventricular pacing. </span></span></span></p>
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