Does left bundle branch area pacing improve heart failure outcomes in patients aged over 75 years?
M Rodrigues Simoes, A L Rocha, D Martinez, I Cruz, M J Primo, L Paiva, J Ferreira, L GoncalvesAbstract
Introduction
Left bundle branch area pacing (LBBAP) has emerged as a physiologic alternative to right ventricular pacing (RVP), reducing desynchrony that can lead to pacing-induced cardiomyopathy. As elderly patients are especially susceptible to heart failure, LBBAP can offer additional protection in this high-risk population.
Methods
We conducted a single-centre retrospective, observational study including patients over 75 years who underwent cardiac implantable electronic devices implantation between September 2022 and September 2025. The objective was to compare LBBAP with RVP, in patients with implanted pacemakers, regarding Emergency Department (ED) admissions due to heart failure (HF), hospitalization for HF, and all-cause mortality. Informatized clinical files were reviewed, and statistical analysis was performed using SPSS.
Results
A total of 1174 patients were included, of whom 726 were men and 448 were women. The mean age was 83.09± 5.02 years, and the median follow-up time was 679 (IQR 633) months. Of these patients, 372 patients underwent LBBAP and 784 received RVP. No significant differences were observed between the groups regarding past medical history, such as hypertension (LBBAP: n= 139 vs RVP: n=327, p=0.342), coronary artery disease (LBBAP: n= 27 vs RVP: n= 52, p=0.464), diabetes mellitus (LBBAP: n= 66 vs RVP: n= 137, p=0.478), or chronic kidney disease (CKD) (LBBAP: n= 20 vs RVP: n= 57, p=0.349). The LBBAP group had a significantly lower median left ventricular ejection fraction (LVEF) compared with the RVP group: 55% (IQR 12.75) vs 57% (IQR 5), p<0.001. The LBBAP group also had a higher median pacing percentage: 94.65% (IQR 67.75) vs 76% (IQR 85.5), p<0.001. For hospitalization due to HF, 14 patients in the LBBAP group and 75 patients in the RVP group were hospitalized; however the difference was not statistically significant (OR 0.743, 95% CI 0.357-1.548; p=0.415). Regarding all-cause mortality, although fewer death occurred in the LBBAP group (n=26 vs n=106), the difference was not significant (OR 0.929, 95% CI 0.599-1.439; p=0.739). The LBBAP group had significantly fewer ED admissions for HF (n=14 vs n=75; b= -0.626, HR 0.535, 95% CI 0.302-0.948; p=0.022).
Conclusion
Among older patients, LBBAP seems to reduce ED admissions for heart failure compared with right ventricular pacing.