Feasibility, safety, electrophysiological characteristics and mid-term
outcomes of Selective Left bundle branch pacing -- Indian perspective
Background: His bundle pacing (HBP) has evolved as the most
physiological form of pacing but associated with limitations. Recently
left bundle branch pacing (LBBP) is emerging as an effective alternative
strategy for HBP. Objectives: Our study was designed to assess the
feasibility, efficacy, electrophysiological parameters and mid-term
outcomes of LBBP in Indian population Methods: All patients requiring
permanent pacemaker implantation for symptomatic bradycardia and heart
failure were prospectively enrolled. Echocardiography, QRS duration,
pacing parameters, Left bundle(LB) potentials, paced QRS duration and
peak left ventricular activation time (pLVAT) recorded. Results: LBBP
was successful in 93 out of 99 patients (94% acute success). Mean age
62.6 ± 13 yrs. Male 59%, diabetes 69%, coronary artery disease 65%.
Follow up duration 4.8 months (range1-12 months). Indication for pacing
were atrioventricular (AV) block 43%, cardiac resynchronization therapy
40%, AV node ablation 4%. LB potential noted in 37 patients (40%).
QRS duration reduced from 144.38 ±34.6ms at baseline to 110.8 ±12.4ms
after LBBP (p value 0.0001). Pacing threshold was 0.59 ± 0.22V and
sensed R wave 14.14 ± 7.19 mV and it remained stable during follow up.
Lead depth in the septum was 9.62 mm. LV ejection fraction increased
from 44.96 % to 53.3 % after LBBP (p value 0.0001). One died due to
respiratory tract infection on follow up Conclusion: LBBP is a safe and
effective strategy (94% acute success) of physiological pacing. The
pacing parameters remained stable over a period of 12 months follow up.
LBBP can effectively overcome the limitations of HBP