Leadless Left Bundle Branch Area Pacing in Cardiac Resynchronisation Therapy: Advances, Challenges and Future Directions

Nadeev Wijesuriya; Mark K Elliott; Vishal Mehta; Baldeep S Sidhu; Marina Strocchi; Jonathan M Behar; Steven Niederer; Christopher A Rinaldi

doi:10.3389/fphys.2022.898866

Leadless Left Bundle Branch Area Pacing in Cardiac Resynchronisation Therapy: Advances, Challenges and Future Directions

Front Physiol. 2022 Jun 6:13:898866. doi: 10.3389/fphys.2022.898866. eCollection 2022.

Authors

Nadeev Wijesuriya^{1

2}, Mark K Elliott^{1

2}, Vishal Mehta^{1

2}, Baldeep S Sidhu^{1

2}, Marina Strocchi¹, Jonathan M Behar^{1

2}, Steven Niederer¹, Christopher A Rinaldi^{1

2}

Affiliations

¹ School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
² Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.

Abstract

Leadless left bundle branch area pacing (LBBAP) represents the merger of two rapidly progressing areas in the field of cardiac resynchronisation therapy (CRT). It combines the attractive concepts of pacing the native conduction system to allow more physiological activation of the myocardium than conventional biventricular pacing, with the potential added benefits of avoiding long-term complications associated with transvenous leads via leadless left ventricular endocardial pacing. This perspective article will first review the evidence for the efficacy of leadless pacing in CRT. We then summarise the procedural steps and pilot data for leadless LBBAP, followed by a discussion of the safety and efficacy of this novel technique. Finally, we will examine how further mechanistic evidence may shed light to which patients may benefit most from leadless LBBAP, and how improvements in current experience and technology could promote widespread uptake and expand current clinical indications.

Keywords: cardiac resynchoronization therapy; conduction system pacing; endocardial pacing; heart failure; leadless cardiac pacing; leadless cardiac resynchronization therapy; left bundle branch area pacing.