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Delivering Physiological Pacing in Routine Practice: Real-World Outcomes of Left Bundle Branch Pacing
Session:
Sessão de Posters 01 - Estimulação do sistema de condução: LBBAP na prática
Speaker:
Beatriz Vargas Andrade
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.6 Device Therapy - Other
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Beatriz Vargas Andrade; Diogo Ferreira; Marta Vilela; Daniel Cazeiro; Andreia Magalhães; Sara Pereira; Pedro António; Pedro Marques; João de Sousa; Fausto J. Pinto; Nelson Cunha
Abstract
<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="font-size:12.0pt">Background:</span></strong><br /> <span style="font-size:12.0pt">Left bundle branch area pacing (LBBAP) has emerged as a physiologic pacing strategy capable of preserving native ventricular activation and improving ventricular synchrony and cardiac function. However, real-world data on procedural performance and early cardiac remodeling in multimorbid populations remains limited.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="font-size:12.0pt">Purpose:</span></strong><br /> <span style="font-size:12.0pt">To characterize the experience of LBBAP implantation in a tertiary university hospital and to evaluate early electrical, echocardiographic and clinical outcomes following LBBAP implantation in a consecutive cohort of patients.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="font-size:12.0pt">Methods:</span></strong><br /> <span style="font-size:12.0pt">A retrospective, observational, single-center study was conducted, including 71 patients who underwent LBBAP implantation. Baseline clinical characteristics, pacing indication, procedural metrics and complications were collected. Clinical outcomes, electrocardiographic and echocardiographic parameters were assessed at baseline and follow-up.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="font-size:12.0pt">Results:</span></strong><br /> <span style="font-size:12.0pt">Mean age was 79±8 years, 44% were female, and comorbidities were highly prevalent. AV node dysfunction was the most common indication for implant in 42 patients (56%) followed by sinus node dysfunction (25%), atrial fibrillation with slow ventricular conduction (12%), and after AV node ablation (3%). In 2 patients (3%) LBBAP was performed with the pursuit of resynchronization: left ventricular ejection fraction (LVEF) <35% and left bundle branch block. Mean LVEF pre-implantation was 45±12%.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="font-size:12.0pt">Implantation success rate was 95%, with a mean procedure duration of 70±20 minutes and fluoroscopy time of 12±11 minutes. Complications were infrequent and with similar rates to those described in the literature for right ventricular pacing, including one pneumothorax (1.4%) and one lead dislodgement (1.4%).</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="font-size:12.0pt">During 8 months of mean follow-up, LBBAP achieved significant electrical improvement with QRS narrowing from 136±32 to 122 ms (p=0.002). Echocardiography demonstrated favourable remodeling with increases in LVEF (45±12% to 52±10%, p<0.01) and GLS (–12.4±3.6% to –13.5±3.1%, p=0.023) and a reduction in LA volume index (49.4±27.2 to 44.7±25.4 mL/m², p=0.013). LV volumes showed a non-significant trend toward reduction. NYHA class and NT-proBNP remained unchanged.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="font-size:12.0pt">Conclusion:</span></strong><br /> <span style="font-size:12.0pt">In a real-world tertiary-centre cohort, LBBP was safe, feasible and associated with marked electrical resynchronization and early signs of favourable cardiac remodeling. These findings support LBBP as an effective physiological pacing strategy across a broad clinical population.</span> </span></span></p>
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