Detailed One-Year Follow-Up in Left Bundle Branch Area Pacing: Echocardiography, Natriuretic Peptide, Electrical Parameters and Complications.

Background

LBBAP is a promising method of cardiac pacing. Data on some follow-up details are still limited. We aimed to evaluate LBBAP over a one-year follow-up period.

Methods

The studied population consisted of 110 patients who underwent LBBAP device implantation (93 for bradycardia indications, 17 for CRT). Echocardiography and NT-proBNP measurement were performed before the procedure and after one year. Electrical parameters, complications and some other conditions that required attention were noted during the observation period.

Results

In total, 89 patients completed the one-year follow-up. NT-proBNP and echocardiographic parameters (LVEF, left ventricular end-diastolic dimension, left atrium dimension) improved after the one-year follow-up, especially in the patients with CRT indications, but also in the bradycardia patients. The independent predictors of a positive heart function response were higher baseline NT-proBNP and the presence of either RBBB or LBBB. The electrical parameters were satisfactory but a slight raise in the pacing threshold was observed at subsequent control visits. Major complications occurred in 4.5% of patients in the acute phase and in 4.4% during the follow-up (the most common was dislodgement of the non-LBBAP lead). One patient is presumed to have developed pacing-induced cardiomyopathy. The most frequent mild complications were intraprocedural RBBB (9.1%) and conversion to deep septal pacing during the follow-up period (5.5%). In addition, 4.4% of the patients required individual programming of the pacing output to maintain the optimal type of capture.

Conclusions

The impact of LBBAP device implantation on cardiac function parameters is positive in a wide range of indications, especially in patients with RBBB or LBBB. The prevalence of complications is relatively high but major complications are rarely associated with LBBAP issues.