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Av block w moderate ivcd1/9/2024 ![]() The determination of LBBB pattern is conventionally made by assessment of surface 12-lead ECGs and can include patients with and without conduction block, as assessed by invasive electrophysiology study (EPS). The ability to normalize wide QRS patterns with His bundle pacing (HBP) has called this notion into question. One historical presumption of LBBB has been that the underlying pathophysiology involved diffuse disease throughout the distal conduction system. Left bundle branch block (LBBB) is associated with improved outcome after cardiac resynchronisation therapy (CRT). Contrary to HBP, LBBAP success rates remain high over the entire spectrum of AV conduction disease and lead parameters remain stable during follow-up. LBBAP is safe and feasible with high success rates for patients with AV conduction disease. There were 4 (1.2%) acute LBBAP lead dislodgements. Mean LBBAP threshold was 0.77☐.34V at 0.4ms at implant and remained stable during follow-up. Procedural success rates did not differ between indications (92.6%, 93.6%, 92.9% and 95% respectively) or between patients with narrow (<120ms) versus wide QRS (≥120ms). LBBB and RBBB were present in 57 patients (16%) and 140 patients (38%) respectively. Pacing indications were Mobitz I in 27 patients (7%), Mobitz II or 2:1 AV block or high-grade AV block in 94 patients (26%), complete heart block in 199 patients (55%) and sick sinus syndrome with isolated bundle branch block in 44 patients (12%). ![]() Mean age was 72☑3 years and mean follow-up was 331☒44 days. LBBAP was successful in 340/364 (93%) patients. Baseline demographic characteristics, procedural success rates, electrophysiological parameters and complications were assessed. Patients with AV conduction disease referred for pacemaker implantation at two centers between 02/2019 and 6/2021 were considered for LBBAP. To evaluate the feasibility, safety, and electrophysiological characteristics of LBBAP in patients with AV conduction disease. The success rate of left bundle branch area pacing (LBBAP) in this cohort is not well studied. The reported success rate of His bundle pacing (HBP) in patients with infranodal atrioventricular (AV) conduction disease is only 52-76%.
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