Complications with left bundle branch area pacing

In the quest for physiological cardiac pacing, investigators from The Netherlands first reported in 2002 a feasibility study of left ventricular septal (LVS) pacing in goats, using a modified Biotronik (Berlin, Germany) Y60 stylet-driven lead with an 11-mm fixed electrically active helix and a guiding sheath. 1 Grosfeld M.J. Res J.C. Vos D.H. de Boer T.J. Bos H.J. Testing a new mechanism for left interventricular septal pacing: the transseptal route; a feasibility and safety study. Europace. 2002; 4: 439-444 Google Scholar The first chronic in-man LVS implantations were reported in 10 patients in 2016 using a modification of the lumenless Medtronic (Minneapolis, MN) 3830 lead, with an extended 4-mm helix. 2 Mafi-Rad M. Luermans J.G. Blaauw Y. et al. Feasibility and acute hemodynamic effect of left ventricular septal pacing by transvenous approach through the interventricular septum. Circ Arrhythm Electrophysiol. 2016; 9e003344 Google Scholar In 2017, Huang et al 3 Huang W. Su L. Wu S. et al. A novel pacing strategy with low and stable output: pacing the left bundle branch immediately beyond the conduction block. Can J Cardiol. 2017; 33 (.e1731–1736.e1733): 1736 Google Scholar reported for the first time left bundle branch area pacing (LBBAP) using the 3830 lead. Recently, LBBAP has been gaining widespread interest as an alternative to His-bundle pacing (HBP), mainly due to superior electrical parameters and shorter procedure durations, 4 Hua W. Fan X. Li X. et al. Comparison of left bundle branch and His bundle pacing in bradycardia patients. JACC Clin Electrophysiol. 2020; 6: 1291-1299 Google Scholar although there are pros and cons with both techniques. 5 Burri H. Seeking the sweet spot for left bundle branch pacing. J Cardiovasc Electrophysiol. 2020; 31: 843-845 Google Scholar LBBAP has shown promising results compared to right ventricular pacing 6 Sharma P.S. Patel N.R. Ravi V. et al. Clinical outcomes of left bundle branch area pacing compared to right ventricular pacing: results from the Geisinger-Rush Conduction System Pacing Registry. Heart Rhythm. 2022; 19: 3-11 Google Scholar as well as biventricular pacing 7 Vijayaraman P. Ponnusamy S. Cano Ó. et al. Left bundle branch area pacing for cardiac resynchronization therapy: results from the International LBBAP Collaborative Study Group. JACC Clin Electrophysiol. 2021; 7: 135-147 Google Scholar ; however, randomized data are lacking. Electrophysiological characteristics of septal perforation during left bundle branch pacingHeart RhythmVol. 19Issue 5PreviewLeft bundle branch pacing (LBBP) provides a low and stable threshold by direct capture of left bundle fibers on the left ventricular subendocardium. As the procedure involves the deployment of the pacing lead deep inside the septum, septal perforation is a potential complication. Full-Text PDF