# Outcomes of Left Bundle Branch Area Pacing in Heart Failure Patients: A Systematic Review

## TL;DR

Left bundle branch area pacing improves heart function and reduces hospitalizations in heart failure patients compared to traditional pacing methods.

## Contribution

This systematic review evaluates the clinical outcomes of LBBAP in heart failure patients, highlighting its efficacy and safety.

## Key findings

- LBBAP significantly increased left ventricular ejection fraction and reduced QRS duration.
- Heart failure-related hospitalizations were lower with LBBAP compared to biventricular pacing.
- Complication rates were low, with rare events like pneumothorax and lead dislodgement.

## Abstract

Left bundle branch area pacing (LBBAP) is an emerging physiological pacing technique that restores ventricular electrical synchrony by directly engaging the left conduction system. It has been proposed as an alternative to conventional pacing strategies, particularly in heart failure patients with reduced left ventricular ejection fraction (LVEF ≤ 50%).

A systematic literature search of PubMed, MEDLINE, and Scopus was conducted up to December 2024 in accordance with PRISMA guidelines. Sixteen studies involving 5680 patients were included. Reported outcomes included changes in LVEF, QRS duration (QRSd), hospitalization rates, complications, and mortality. Due to heterogeneity among studies, a qualitative narrative synthesis was performed.

LBBAP was associated with significant improvements in cardiac function, with most studies reporting increased LVEF and marked reductions in QRSd, indicating improved electrical synchrony. Complication rates were low, with rare events such as pneumothorax and lead dislodgement. Heart failure–related hospitalizations were lower with LBBAP compared with biventricular pacing (19.05% vs. 30.00%), while mortality rates remained low across pacing strategies. Overall, LBBAP demonstrated superior electrical resynchronization and favorable clinical outcomes compared with conventional pacing modalities.

LBBAP is a promising pacing strategy that improves electrical synchrony and cardiac function with a favorable short‐ to mid‐term safety profile. Further large‐scale randomized studies are needed to establish its long‐term efficacy and safety.

LBBAP demonstrated significant improvements in cardiac function, with most studies reporting substantial increases in LVEF and reductions in QRSd. LBBAP is a promising alternative to conventional pacing strategies, offering superior electrical and mechanical synchronization, enhanced cardiac function, and better clinical outcomes.