AIMS: Permanent transseptal left bundle branch area pacing (LBBAP) is a promising new pacing method for both bradyarrhythmia and heart failure indications. However, data regarding safety, feasibility and capture type are limited to relatively small, usually single centre studies. In this large multicentre international collaboration, outcomes of LBBAP were evaluated. METHODS AND RESULTS: This is a registry-based observational study that included patients in whom LBBAP device implantation was attempted at 14 European centres, for any indication. The study comprised 2533 patients (mean age 73.9 years, female 57.6%, heart failure 27.5%). LBBAP lead implantation success rate for bradyarrhythmia and heart failure indications was 92.4% and 82.2%, respectively. The learning curve was steepest for the initial 110 cases and plateaued after 250 cases. Independent predictors of LBBAP lead implantation failure were heart failure, broad baseline QRS and left ventricular end-diastolic diameter. The predominant LBBAP capture type was left bundle fascicular capture (69.5%), followed by left ventricular septal capture (21.5%) and proximal left bundle branch capture (9%). Capture threshold (0.77 V) and sensing (10.6 mV) were stable during mean follow-up of 6.4 months. The complication rate was 11.7%. Complications specific to the ventricular transseptal route of the pacing lead occurred in 209 patients (8.3%). CONCLUSIONS: LBBAP is feasible as a primary pacing technique for both bradyarrhythmia and heart failure indications. Success rate in heart failure patients and safety need to be improved. For wider use of LBBAP, randomized trials are necessary to assess clinical outcomes.

1st Department of Cardiology Interventional Electrocardiology and Hypertension Jagiellonian University Medical College Jakubowskiego 2 30 688 Krakow Poland

Arrhythmia and Electrophysiology Unit Cardiology Department Santa Maria Della Misericordia Hospital Rovigo Italy

Cardiac Pacing Unit Cardiology Department University Hospital of Geneva Geneva Switzerland

Cardiocenter 3rd Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czechia

Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares 28029 Madrid Spain

Department of Cardiology Cardiovascular Research Institute Maastricht Maastricht the Netherlands

Department of Cardiology Catharina Ziekenhuis Eindhoven the Netherlands

Department of Cardiology Homolka Hospital Prague Czechia

Department of Cardiology Isala Hospital Zwolle Postbus 10400 8000 GK Zwolle the Netherlands

Department of Cardiology Noordwest Ziekenhuisgroep Alkmaar the Netherlands

Department of Cardiology Radboud University Medical Centre Nijmegen the Netherlands

Department of Cardiology University Hospital Antwerp Antwerp Belgium

Division of Cardiology Policlinico Casilino Rome Italy

Electrophysiology Section Cardiology Department Hospital Universitari i Politècnic La Fe Valencia Spain

Heart Center Ghent University Hospital Ghent Belgium

National Heart and Lung Institute Imperial College London London UK

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Eur Heart J. 2022 Oct 21;43(40):4174-4176. doi: 10.1093/eurheartj/ehac447. PubMed

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