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Review
. 2023 Dec 1:12:e29.
doi: 10.15420/aer.2023.15. eCollection 2023.

The Emerging Role of Left Bundle Branch Area Pacing for Cardiac Resynchronisation Therapy

Juan Carlos Diaz  1 , Mauricio Duque  1 , Julian Aristizabal  2 , Jorge Marin  2 , Cesar Niño  3 , Oriana Bastidas  3 , Luis Miguel Ruiz  4 , Carlos D Matos  5 , Carolina Hoyos  5 , Daniela Hincapie  5 , Alejandro Velasco  6 , Jorge E Romero  5
Affiliations
Review

The Emerging Role of Left Bundle Branch Area Pacing for Cardiac Resynchronisation Therapy

Juan Carlos Diaz et al. Arrhythm Electrophysiol Rev. .

Abstract

Cardiac resynchronisation therapy (CRT) reduces the risk of heart failure-related hospitalisations and all-cause mortality, as well as improving quality of life and functional status in patients with persistent heart failure symptoms despite optimal medical treatment and left bundle branch block. CRT has traditionally been delivered by implanting a lead through the coronary sinus to capture the left ventricular epicardium; however, this approach is associated with significant drawbacks, including a high rate of procedural failure, phrenic nerve stimulation, high pacing thresholds and lead dislodgement. Moreover, a significant proportion of patients fail to derive any significant benefit. Left bundle branch area pacing (LBBAP) has recently emerged as a suitable alternative to traditional CRT. By stimulating the cardiac conduction system physiologically, LBBAP can result in a more homogeneous left ventricular contraction and relaxation, thus having the potential to improve outcomes compared with conventional CRT strategies. In this article, the evidence supporting the use of LBBAP in patients with heart failure is reviewed.

Keywords: Heart failure; cardiac resynchronisation therapy; conduction system pacing; heart failure-related hospitalisation; left bundle branch area pacing.

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Conflict of interest statement

Disclosure: JCD has received honoraria and is a proctor for Medtronic for left bundle branch area pacing. JER has received grants from Biosense Webster, Medtronic and MMC; consulting fees from Abbott, AtriCure, Biosense Webster and Sanofi; and has received honoraria from Biosense Webster and Boston Scientific. All other authors have no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Stepwise Approach to Device Programming in Patients with Heart Failure
Figure 2:
Figure 2:. Importance of Adequate Device Programming During Left Bundle Branch Area Pacing
Figure 3:
Figure 3:. Paced QRS Duration, Change in LVEF and Procedural Characteristics of the Observational Studies Comparing LBBAP with Biventricular Pacing
Figure 4:
Figure 4:. Recent Observational Studies Comparing Left Bundle Branch Area Pacing With Biventricular Pacing
Figure 5:
Figure 5:. Right Anterior Oblique Projection Demonstrating Several Fluoroscopic Landmarks Can be Used to Avoid Procedure-related Complications During Left Bundle Branch Area Pacing
See this image and copyright information in PMC

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