Feasibility and safety of left bundle branch area pacing-cardiac resynchronization therapy in elderly patients.

Abstract

BACKGROUND:

Left bundle branch area pacing (LBBAP) is an emerging technique to achieve cardiac resynchronization therapy (CRT), but its feasibility and safety in elderly patients with heart failure with reduced ejection fraction and left bundle branch block is hardly investigated.

METHODS:

We enrolled consecutive patients with an indication for CRT comparing pacing parameters and complication rates of LBBAP-CRT in elderly patients (≥ 75 years) versus younger patients (< 75 years) over a 6-month follow-up.

RESULTS:

LBBAP was successful in 55/60 enrolled patients (92%), among which 25(45%) were elderly. In both groups, LBBAP significantly reduced the QRS duration (elderly group: 168 ± 15 ms to 136 ± 12 ms, p < 0.0001; younger group: 166 ± 14 ms to 134 ± 11 ms, p < 0.0001) and improved LVEF (elderly group: 28 ± 5% to 40 ± 7%, p < 0.0001; younger group: 29 ± 5% to 41 ± 8%, p < 0.0001). The pacing threshold was 0.9 ± 0.8 V in the elderly group vs. 0.7 ± 0.5 V in the younger group (p = 0.350). The R wave was 9.5 ± 3.9 mV in elderly patients vs. 10.7 ± 2.7 mV in younger patients (p = 0.341). The fluoroscopic (elderly: 13 ± 7 min vs. younger: 11 ± 7 min, p = 0.153) and procedural time (elderly: 80 ± 20 min vs. younger: 78 ± 16 min, p = 0.749) were comparable between groups. Lead dislodgement occurred in 2(4%) patients, 1 in each group (p = 1.000). Intraprocedural septal perforation occurred in three patients (5%), 2(8%) in the elderly group (p = 0.585). One patient (2%) in the elderly group had a pocket infection.

CONCLUSIONS:

LBBAP is a feasible and safe technique for delivering physiological pacing in elderly patients who are candidates for CRT with suitable pacing parameters and low complication rates.

• Authors: Domenico Grieco, Edoardo Bressi, Kamil Sedláček, Karol Čurila, Kevin Vernooy, Elisa Fedele, Ermenegildo De Ruvo, Alessandro Fagagnini, Jordana Kron, Santosh K Padala, Kenneth A Ellenbogen, Leonardo Calò
• Journal: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing (J Interv Card Electrophysiol) Vol. 66 Issue 2 Pg. 311-321 (Mar 2023) ISSN: 1572-8595 [Electronic] Netherlands
• PMID: 35266067 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Topics

• Humans
• Aged
• Cardiac Resynchronization Therapy (methods)
• Bundle of His
• Cardiac Pacing, Artificial (adverse effects, methods)
• Feasibility Studies
• Electrocardiography (methods)
• Treatment Outcome
• Stroke Volume