Rate and nature of complications of conduction system pacing compared with right ventricular pacing: Results of a propensity score–matched analysis from a multicenter registry

Ablate and pace: Comparison of outcomes between conduction system pacing and biventricular pacing

“…In our study, the rate of complications observed in LBBAP patients was 2.4%, consistent with the rate reported in many previous studies, ranging from 1.6% to 5%, 16,28,30 but significantly lower than that reported in the Multicentre European Left Bundle Branch Area Pacing Outcomes Study (MELOS), in which a rate of total complications of 11.7% was reported. 31 In order to exclude adverse events without significant clinical impact, in our study we chose a priori to analyze only the complications directly related to device implantation resulting in re-hospitalization, prolonged hospitalization by at least 48 h, and/or in pacing system surgical revision, or lead deactivation.…”

“…In accordance with the results of previous studies, 13–16 our data confirm that, when compared with HBP and CS leads, LBBAP leads allow to obtain lower acute capture thresholds, which tend to remain low and stable during follow‐up. This finding is clinically relevant as the achievement of low capture thresholds that remain stable over time reduces the risk of lead revision or deactivation for excessive rise in capture threshold (complications that may occur in 6.7%–10.4% for the HBP lead, 13,16,26–28 and in 3.7%–7.7% for the CS lead 23,17 ), and has a positive impact on device longevity, reducing the number of device replacements and therefore the related risk of complications 23,29 …”

“…Device-related complications were predefined as any device-related adverse event that was identified after the implantation procedure resulting in death, permanent loss of device function due to mechanical or electrical dysfunction, hospitalization, prolonged hospitalization by at least 48 h, or pacing system surgical revision. [23][24][25] For details on definitions of complications [23][24][25][26][27][28] see Supplementary materials.…”

Left bundle branch area pacing (LBBAP) Auto Threshold algorithms Evaluation for Conduction System Pacing: The LATECS pilot Trial

“…The last evolution of CSP is represented by left bundle branch area pacing (LBBAP), a novel technique first described by Huang et al 15 that was designed to overcome the limitations of HBP and that is showing very promising results in keeping optimal electromechanical biventricular activation and in reversing ventricular dyssynchrony due to intraventricular conduction delays, [16][17][18] with safety and complication rates similar to traditional right ventricle pacing. 19 The application of ATM algorithms to HBP has several limitations and is usually contraindicated: first of all, depending on the sensing methods adopted to read the evoked response of the ventricles, pacing in a fibrous tissue (the surroundings of the His bundle) may prevent correct recognition of occurred depolarization; secondly, prolonged non-standard impulse durations are adopted (i.e., 1 ms or longer), thus preventing the activation of the algorithms in most devices; third, based on EGMs read by the device, with the present technology it is nearly impossible to discriminate between myocardial capture and selective HBP, therefore vanishing the benefits of CSP in case of auto-programming of a pacing output that captures the myocardium surrounding HBP without activating the conduction system and making virtually impossible to assess real HBP threshold.…”

“…The last evolution of CSP is represented by left bundle branch area pacing (LBBAP), a novel technique first described by Huang et al 15 . that was designed to overcome the limitations of HBP and that is showing very promising results in keeping optimal electromechanical biventricular activation and in reversing ventricular dyssynchrony due to intraventricular conduction delays, 16–18 with safety and complication rates similar to traditional right ventricle pacing 19 …”