# Left Bundle Branch Area Pacing in Older Patients: A New Opportunity?

## TL;DR

This paper reviews the safety and effectiveness of left bundle branch area pacing in older patients with heart failure.

## Contribution

The study provides insights into the application of LBBAP in patients aged ≥75 years, a group with limited data.

## Key findings

- LBBAP is safe and effective in older patients with outcomes comparable to younger patients.
- Current data on LBBAP in patients with cardiac amyloidosis remain inconclusive.
- LBBAP is suggested to be cost-effective and could be integrated with defibrillator capabilities in the future.

## Abstract

Background: Resynchronization therapy has become a cornerstone in patients with heart failure (HF). Recent advancements in this field have led to the development of the so-called “left bundle branch area pacing” (LBBAP), a form of pacing where a single ventricular catheter directly addresses the left bundle for a more physiological stimulation. The current literature provides encouraging evidence regarding this topic, but there is still limited data for the older population, particularly those aged ≥75 years. This review aims to clarify how LBBAP has been explored in this cohort and if its application could be safe and effective even in the most advanced stages of life. Methods: A search of articles from PubMed was conducted. Patients were considered older if above 75 years of age. Data regarding Italian statistics were obtained from national registries. Results: The current literature supports the safety and effectiveness of LBBAP in older patients across different indications, with outcomes comparable to those reported in younger patients and a suggested cost-effectiveness. Conversely, data regarding patients affected by cardiac amyloidosis are still inconclusive. Conclusions: LBBAP represents a valuable resource for patients of all ages, but frailty is a major issue in the older population that needs to be addressed. The potential integration of this technology with defibrillator capabilities will enable an even more extensive application in the near future.