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Feasibility of Left Bundle Branch Area Pacing in post-valvular open-heart surgery patients: a comparative study with right ventricular conventional pacing
Session:
Sessão de Posters 19 - Temas quentes em pacing e eletrofisiologia na era atual
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; Luísa Gomes Rocha; Ana L. Silva; Maria João Primo; Didier Martinez; Rita Ventura; Inês Brito e Cruz; 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">Introduction: Left bundle branch area pacing (LBBAP) is emerging as the preferred physiological pacing strategy, with studies demonstrating better outcomes than conventional right ventricular (RV) pacing. Because LBBAP requires lead penetration through the interventricular septum, prior open-heart surgery may pose technical challenges due to septal fibrosis.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Methods: A single-center, retrospective study included patients who underwent LBBAP between September 2022 and December 2024. Data on pacing indications, prior valve surgery, and procedural characteristics were collected. We evaluated the feasibility of LBBAP in patients with prior valvular surgery—including aortic, mitral, or tricuspid procedures—compared to RV pacing. The primary endpoint was a composite of emergency visits or hospitalizations for heart failure. Median follow-up was 753 days (IQR=370).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Results: The analysis included 56 post–open-heart surgery patients receiving pacemakers (62.5% male; mean age 68.7±1.66 years). Surgeries were aortic 69.1%, mitral 21.8%, and mixed 8.9% (p=0.159). Pacing indications were complete heart block 30 (53.6%), bradycardia 11 (19.6%), and second-degree block in the remainder. Thirty-three patients (58.9%) received LBBAP and 23 (41.1%) RV pacing, with no differences in cardiovascular risk factors or surgery type. Median LVEF was 55% (IQR 13.5), slightly lower in LBBAP (52%, IQR 22.25; p=0.005). Procedure duration was similar (63.9 ± 2.5 min; p>0.05). Mean intrinsic QRS was 145.4 ± 4.47ms; paced QRS was narrower with LBBAP (127.4 ± 3.6ms) versus RV (166.4 ± 6.0ms; p<0.001). Capture thresholds and sensed R waves were similar (0.52 ± 0.04V and 13.7 ± 0.82mV), p>0.05. Median ventricular pacing was 90.7% (IQR 87), higher in LBBAP (98.4% [IQR 15.1] vs 15.6% [IQR 73.4]; p<0.001). Regarding primary composite endpoint, Kaplan-Meier analysis showed similar 2-year event-free survival for LBBAP and RV (91.2% vs 88.8%; p=0.802).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Conclusion: In patients with prior open-heart surgery and potentially altered septal anatomy, LBBAP was feasible and procedurally safe, having achieved narrower paced QRS durations, comparable to conventional RV pacing. Over a 2-year follow-up, clinical outcomes were comparable, supporting LBBAP as a viable and physiologically favorable pacing strategy even in patients with post-surgical septal distortion. The substantially higher ventricular pacing percentages in LBBAP group compared to RV may have an influence on the similar outcomes observed.</span></span></p>
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