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Feasibility, Safety And Efficacy Of Left Bundle Branch Pacing In Octogenarians
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  • Shunmuga Sundaram,
  • Dasarath Boppana,
  • Mahesh Kumar,
  • Giridhar Muthu,
  • Vijesh Anand,
  • Suryakumar Balasubramanian
Shunmuga Sundaram
Velammal Medical College Hospital and Research Institute
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Dasarath Boppana
Velammal Medical College Hospital and Research Institute
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Mahesh Kumar
Velammal Medical College Hospital and Research Institute
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Giridhar Muthu
Velammal Medical College Hospital and Research Institute
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Vijesh Anand
Velammal Medical College Hospital and Research Institute
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Suryakumar Balasubramanian
Velammal Medical College Hospital and Research Institute
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Abstract

Background: Left bundle branch pacing (LBBP) provides physiological pacing at low and stable threshold. The safety and efficacy of LBBP in elderly population is unknown. Objectives: Our study was designed to assess the safety, efficacy and electrophysiological parameters of LBBP in octogenarian (≥80 years) population Methods: All octogenarians requiring permanent pacemaker implantation for symptomatic bradycardia and heart failure were prospectively enrolled. Echocardiography, electrocardiography and pacing parameters were recorded. Results: LBBP was successful in 10 out of 11 patients. Mean age 82.1 ± 2.5 yrs. Male 7 patients. Follow up duration 4.7 months (range1-7months). Indication for pacing included atrioventricular (AV) block 5 patients, Left bundle branch block (LBBB) with low ejection fraction (EF) 4 patients, sinus node dysfunction in 1. LB lead placement fluoroscopic time was 17.9 minutes. QRS duration reduced from 145.9 ±27.7ms at baseline to 107.1 ±9.5ms after LBBP (p value0.00001) LV ejection fraction increased from 47.6 % to 55.9 % after LBBP (p value0.017). Pacing threshold was 0.58 ± 0.22V and sensed R wave 17.35 ± 6.5mV and it remained stable during follow up. LBBB with low EF patients also showed similar reduction in QRS duration along with improvement in LVEF. No major complications noted Conclusion: LBBP is a safe and effective strategy (91% acute success) of physiological pacing in elderly patients. LBBP also provided effective resynchronization therapy in our small group of elderly patients. The pacing parameters remained stable over a period of 7 months follow up.