Our Initial Experience of Left Bundle Branch Area Pacing (LBBAP) With Stylet-Driven Pacing Leads (SDL) in a Tertiary Care Center

TL;DR

This paper reports on the successful use of a new pacing technique in a hospital in India, showing it is safe and effective for most patients.

Contribution

The study provides initial clinical experience with LBBAP using stylet-driven pacing leads in a specific geographic region.

Findings

LBBAP implant success was achieved in 90% of patients.

Significant differences were found in bundle branch block and pacing indications.

Unipolar and bipolar impedance comparison showed statistically significant results.

Abstract

Background

The use of left bundle branch area pacing (LBBAP) as a substitute for conduction system pacing (CSP) is becoming increasingly popular. Thus, this study was performed to evaluate the feasibility, safety, and outcomes of LBBAP with stylet-driven pacing leads (SDL) in a tertiary care center in Eastern India.

Materials and methods

This single-center, retrospective study was conducted at the Department of Cardiology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India. The study included data from 20 patients over one year, i.e., from December 2023 to December 2024. The procedure-related characteristics included fluoroscopy exposure duration, doses, and patterns of electrocardiograms (ECG) and intracardiac electrograms (EGM) that were documented during implantation. The Institutional Ethics Committee (IEC), IGIMS, Patna, Bihar, India, has granted ethical approval (approval no. 291/IEC/IGIMS/2025, dated January 9, 2025).

Results

Implant success was observed in 18 (90%) patients. Significant differences were observed in bundle branch block and pacing indications with p-values <0.001 and 0.002, respectively. It was noted that a highly statistically significant result was obtained when unipolar impedance and bipolar impedance were compared, with a p-value of 0.002.

Conclusion

Our study found that permanent LBBAP is a viable physiological pacing method with a 90% success rate. Moreover, septal perforation complications were not noted. Among the limitations of the study were the small number of patients, which might affect the efficiency of the results, and the shorter duration of time. Additionally, the study was retrospective; thus, similar records of some parameters were difficult to find.

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