SPC365

Left Bundle Branch Area Pacing vs Right Ventricular Pacing: Changing the Pacing Paradigm

Session: Sessão de Posters 01 - Estimulação do sistema de condução: LBBAP na prática
Speaker: Inês Araújo

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: Inês Caldeira Araújo; João Cravo; Marta Vilela; Daniel Cazeiro; Diogo Ferreira; Andreia Magalhães; Sara Pereira; Pedro António; Pedro Marques; João de Sousa; Fausto J. Pinto; Nelson Cunha

<p><span style="font-size:10.5pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span><br />
<span style="font-size:10.5pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Right ventricular pacing (RVP) can induce ventricular dyssynchrony and increase the risk of left ventricular dysfunction in patients requiring frequent ventricular pacing. Left bundle branch area pacing (LBBAP) provides a more physiological activation pattern and may offer superior long-term clinical outcomes. However, comparative real-world evidence in patients with preserved left ventricular function remains limited.</span></span></span></p>

<p><span style="font-size:10.5pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Purpose:</strong></span></span></span><br />
<span style="font-size:10.5pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">To compare electrical, echocardiographic and clinical outcomes between LBBAP and RVP in a consecutive cohort from a tertiary center.</span></span></span></p>

<p><span style="font-size:10.5pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span><br />
<span style="font-size:10.5pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">A retrospective, observational study was conducted, including 69 patients with preserved left ventricular ejection fraction (LVEF) who underwent pacemaker implantation (LBBAP n=35; RVAP n=34). Baseline clinical, electrocardiographic and echocardiographic parameters were collected, along with procedural data. Electrical, echocardiographic and clinical outcomes were assessed during follow-up. The primary endpoint was a composite of cardiovascular hospitalization or cardiovascular death, evaluated with Kaplan&ndash;Meier analysis.</span></span></span></p>

<p><span style="font-size:10.5pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span><br />
<span style="font-size:10.5pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Baseline characteristics were comparable between groups. LBBAP procedures were longer and required more fluoroscopy (68.66&plusmn;19.98min and 12.69&plusmn;11.76min versus 37.15&plusmn;10.6min and 4.079&plusmn;4.74min, respectively, both p&lt;0.001), though complication rates remained low and similar. Mean baseline QRS duration was similar (123&plusmn;29ms for LBBAP and 121&plusmn;27ms for RVP), but LBBAP resulted in significant QRS narrowing (-11.5&plusmn;30.1ms) whereas RVP led to QRS widening (+27.0&plusmn;28.0 ms, p&lt;0.001).&nbsp;</span></span></span></p>

<p><span style="font-size:10.5pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">LVEF remained stable in both groups (baseline 60% vs 58%; post-procedure 58% vs 57%). However, LBBAP showed a more favorable echocardiographic profile, including superior GLS changes (&ndash;0.8&plusmn;1.9% vs +1.6&plusmn;3.3%, p=0.032) and nonsignificant improvements concerning left ventricular and atrial volumes, E/e&rsquo; ratio, TAPSE and PSAP.</span></span></span></p>

<p><span style="font-size:10.5pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Clinical outcomes strongly favored LBBAP. Cardiovascular hospitalizations were markedly lower in the LBBAP group (3% vs 38%, p&lt;0.001) and cardiovascular deaths occurred only in the RVP group (0 vs 2, p=ns). Kaplan&ndash;Meier analysis demonstrated a significant reduction in the composite cardiovascular event in the LBBAP group (log-rank &chi;&sup2;=12.8, p&lt;0.001). Patients experiencing events had a high percentage of ventricular pacing (&gt;20%).&nbsp;</span></span></span></p>

<p>&nbsp;</p>

<p><span style="font-size:10.5pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusions:</strong></span></span></span><br />
<span style="font-size:10.5pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">In this real-world population with preserved LVEF, LBBAP provided superior electrical synchrony and a significantly better clinical trajectory compared with RVP. The marked reduction in cardiovascular events and improved survival curves support LBBAP as a safer and more physiological pacing strategy, reinforcing its role as a preferred alternative to traditional RVP in patients with an expected high burden of ventricular pacing.</span></span></span></p>

<p>&nbsp;</p>