Initial Experience, Safety, and Feasibility of Left Bundle Branch Area Pacing: A Multicenter Prospective Study.

TL;DR: Left bundle branch pacing has been developed as an alternative physiologic pacing strategy that overcomes most of His bundle pacing limitations and is summarized in this article.

TL;DR: It is shown that left bundle branch pacing may be safe and feasible in patients who have undergone alcohol septal ablation, despite concerns over potential difficulties with lead implantation and capture.

TL;DR: LBBP offers advantages over HBP, including improved electrical activation, lower pacing thresholds, and shorter procedure and fluoroscopy times, which support LBBP as a feasible and effective alternative to HBP in AVB patients with preserved systolic function.

TL;DR: The case shows a novel pacing strategy for patients with BBB that affects many patients with heart failure, and demonstrates the feasibility of pacing the left bundle branch (LBB) immediately beyond the conduction block to functionally restore the impaired His-Purkinje conduction system.

Abstract: Introduction Studies have demonstrated the feasibility and clinical benefits of permanent His-bundle pacing (HBP). However, concerns regarding higher pacing thresholds, lower R-wave amplitudes, and the potential to develop distal conduction block have limited the clinical application of HBP in certain subgroups. Thus, left bundle branch pacing (LBBP) has emerged as an alternative method for delivering physiological pacing to achieve electrical synchrony of the left ventricle (LV), especially in patients with infranodal atrioventricular block and left bundle branch block (LBBB). The proximal left bundle branches run through the LV septum and fan out to form a wider target for pacing compared to the His bundle. Recently, we reported that HBP can correct classic LBBB in 97% of patients, and Upadhyay et al demonstrated that the site of block usually is located within the His or proximal left bundle. We developed a technique for LBBP using a transseptal approach. LBBP has been reported to offer low pacing thresholds and large R waves, and because the distal conduction system is targeted, has a lower theoretical risk for development of distal conduction block. However, the definitions and implantation procedure have not been previously well described. Here we describe our method for performing LBBP to confirm intraseptal left con-

TL;DR: Permanent HBP was feasible and safe in a large real-world population requiring permanent pacemakers and was associated with reduction in the combined endpoint of death, HFH, or upgrade to BiVP compared to RVP in patients requiring permanentpacemakers.

TL;DR: HBP and LBBAP may significantly increase the overall success of physiologic pacing and be feasible in a high percentage of patients with low thresholds during acute follow-up.