Left bundle branch area pacing in dual-chamber pacemaker implantation: Procedural feasibility and electrical outcomes – Case series

ABSTRACT Right ventricular pacing leads to nonphysiological ventricular activation and causes electrical dyssynchrony and adverse cardiac remodelling. Left bundle branch area pacing (LBBAP) responsible for physiological pacing strategy that preserves synchrony of ventricles by engaging the His–Purkinje system. The objective of the study was to evaluate the procedural feasibility and outcomes of LBBAP in patients undergoing dual chamber pacemaker implantation. In this single center, retrospective observational case series, seven patients undergoing dual chamber pacemaker implantation with LBBAP between January 2025 and January 2026 were included. Procedural success was defined as achievement of stable LBBAP with acceptable pacing parameters and significant QRS narrowing. Electrical parameters include pacing threshold, sensing amplitudes, and lead impedance, were assessed at implantation and prior to discharge. A total of seven patients underwent LBBAP. Successful LBBAP implantation was achieved in 6 of 7 patients (85.7%). The mean procedure time was 75 ± 15 min, with fluoroscopy time of 8 ± 3 min. LBBAP caused important QRS narrowing with stable lead parameters. Mean pacing thresholds of RA and RV were low, measuring 0.66 V in right atrium (RA) and 0.49 V in right ventricle (RV), showing stable lead activity with sufficient sensing and impedance values. No acute procedural complications, including lead dislodgement, cardiac perforation, or pneumothorax, were observed. LBBAP is a feasible and safe physiological pacing strategy in those patients undergoing dual chamber pacemaker implantation, demonstrating high procedural success and favourable short term electrical outcomes. Larger prospective studies are warranted to evaluate long term clinical benefits.