Comparison of Clinical Complications Between LBBAP and Traditional RVP in Long-Term Follow-Up

Background. Traditional right ventricular pacing (RVP) can lead to asynchronous cardiac mechanical contractions and increase the risk of adverse cardiac events. This study aimed to compare the clinical complications between left bundle branch area pacing (LBBAP), which is both novel and physiological, and RVP in a cohort requiring ventricular pacing.
Material and methods. A retrospective study was conducted on patients with initial implantation of a dual-chamber, permanent pacemaker and with ventricular pacing proportion more than 20 % from January 2019 to December 2020. Patients were divided into the LBBAP or RVP group and follow-up was conducted routinely. The primary outcome was ventricular lead complications, including an increase in the ventricular lead threshold or a decrease in R-wave amplitude. Overall complications were defined as ventricular lead complications, ventricular lead dislocation, ventricular lead perforation, adverse cardiovascular events and cardiovascular death.
Results. A total of 248 patients were included in the analysis (LBBAP, n=98; RVP, n=150). The pacing QRS duration in LBBAP patients was significantly shorter than in RVP patients (110.3±22.7 vs 140.0±29.3 ms, p<0.01). For a mean follow-up duration of 13 mos, the risk of ventricular lead complications was higher in the LBBAP group than in the RVP group (62.0 % vs. 36.5 %, p=0.03). LBBAP was comparable to RVP within one year follow-up when considering overall complications. At the one year follow-up ultrasound examinations, the LA in LBBAP group was decreased (p=0.04). Considering the larger initial left ventricular end-diastolic diameter (LVEDD) in the LBBAP group, the similarity of LVEDD values in both groups at follow-up suggested that LVEDD was reduced in patients treated with LBBAP. There was no difference in left ventricular ejection fraction (LBBAP LVEF, baseline = 61.2±8.6 %) between the two groups at baseline or follow-up.
Conclusions. LBBAP patients were more prone to ventricular lead threshold increase and amplitude decrease than RVP patients. The risk of overall complications in the two pacing modalities were equal in one year follow-up duration. LBBAP is safe and effective in patients with VP>20 % and without seriously depressed LVEF.

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