Outcomes of left bundle branch area pacing compared to His bundle pacing and right ventricular apical pacing in Japanese patients with bradycardia

• Published in: Journal of arrhythmia 2024-04, Vol.40 (2), p.333-341
• Main Authors: Kono, Hiroyuki, Kuramitsu, Shoichi, Fukunaga, Masato, Korai, Kengo, Nagashima, Michio, Hiroshima, Kenichi, Ando, Kenji
• Format: Article
• Language: English
• Subjects: atrioventricular block; Bradycardia; Cardiac arrhythmia; Cardiac pacing; Care and treatment; Clinical outcomes; Diagnosis; Evaluation; Heart failure; His bundle pacing; left bundle branch area pacing; Pacemakers; right ventricular apical pacing; Success
• ISSN: 1880-4276; 1883-2148
• DOI: 10.1002/joa3.12997

His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) emerge as better alternatives to right ventricular apical pacing (RVAP) in patients with bradycardia requiring permanent cardiac pacing. We aimed to compare the clinical outcomes of LBBAP, HBP, and RVAP in Japanese patients with bradycardia. A total of 424 patients who underwent successful pacemaker implantation (HBP,  = 53; LBBAP,  = 75; and RVAP,  = 296) were retrospectively enrolled in this study. The primary study endpoint was the cumulative incidence of heart failure hospitalization (HFH) during the follow-up. The success rate for implantation was higher in the LBBAP group than in the HBP group (94.9% and 81.5%, respectively). Capture threshold increase >1V during the follow-up occurred in the HBP and RVAP groups (9.4% and 5.1%, respectively), while it did not in the LBBAP group. The cumulative incidence of HFH was significantly lower in the LBBAP group than the RVAP (adjusted hazard ratio, 0.12 [95% confidence interval: 0.02-0.86];  = .034); it did not differ between the HBP and RVAP groups (adjusted hazard ratio, 0.48 [95% confidence interval: 0.17-1.34];  = .16). Advanced age, mean percent right ventricular pacing (per 10% increase), left ventricular ejection fraction