Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal, ehac445. https://doi.org/10.1093/eurheartj/ehac445 Dr. Marek Jastrzębski et al
Points
- The main goal of this observational study was to evaluate the outcomes of the left bundle branch area pacing (LBBAP) in patients with bradyarrhythmia and heart failure indications, as previously, there was very limited data.
- The results demonstrated that LBBAP is a feasible pacing technique for patients with bradyarrhythmia and heart failure.
- Success rate and safety measures in patients with heart failure need to be improved.
- For use at a large scale, to evaluate clinical benefits, and for generalization purposes, there is a need for randomized trials.
Summary
The adverse outcomes of right ventricular pacing were observed when it was used for the treatment of bradycardia. There were also some limitations to using biventricular pacing when it was used as a method for cardiac resynchronization therapy. These findings encouraged the improvement in more pacing techniques. Mafi-Rad et al. (2016) demonstrated the possibility of permanent left ventricular septal pacing through the ventricular trans-septal route. Then in 2019, Huang et al. modified this technique and demonstrated direct pacing of LBBP by using the trans-septal route.
A registry-based observational study was conducted to assess the left bundle branch area pacing outcomes in patients with bradyarrhythmia and heart failure indications. For this study, 2533 patients, including males and females from 14 different European hospitals, were selected during 2018-2021 in whom the LBBAP device was implanted. Implantation of LBBAP showed a 92.4% success rate in bradyarrhythmia and an 82.2% success rate in patients with heart failure indications.
The results demonstrated that LBBAP is a feasible pacing technique for patients with bradyarrhythmia and heart failure. Results also indicated that the pacing is more challenging in patients with reduced ejection fraction, heart failure, and prolonged QRS duration. The prominent capture type in LBBAP was left fascicular bundle capture. The rate of complications in LBBAP was 8.3%; for more success rate, safety measures in patients with heart failure need to be improved. For use at a large scale, to evaluate clinical benefits, and for generalization purposes, there is a need for randomized trials.
Link to the article: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehac445/6671019
References Jastrzębski, M., Kiełbasa, G., Cano, O., Curila, K., Heckman, L., De Pooter, J., Chovanec, M., Rademakers, L., Huybrechts, W., Grieco, D., Whinnett, Z. I., Timmer, S. A. J., Elvan, A., Stros, P., Moskal, P., Burri, H., Zanon, F., & Vernooy, K. (2022). Left bundle branch area pacing outcomes: The multicentre European MELOS study. European Heart Journal, ehac445. https://doi.org/10.1093/eurheartj/ehac445
