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

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

Research output: Contribution to journal › Article › peer-review

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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.

Original language	English
Article number	898866
Journal	Frontiers in Physiology
Volume	13
DOIs	https://doi.org/10.3389/fphys.2022.898866
Publication status	Published - 6 Jun 2022

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Leadless Left Bundle Branch_WIJESURIJA_Publishedonline6June2022_GOLD VoR CC BYFinal published version, 617 KBLicence: CC BY

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@article{1d59207c01754075b4dad61de0c90ada,

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

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. ",

author = "Nadeev Wijesuriya and Elliott, {Mark K.} and Vishal Mehta and Sidhu, {Baldeep S.} and Marina Strocchi and Behar, {Jonathan M.} and Steven Niederer and Rinaldi, {Christopher A.}",

note = "Funding Information: The authors are supported by the Wellcome/EPSRC Centre for Medical Engineering (WT203148/Z/16/Z). ME and VM have received fellowship funding from Abbott. BS received speaker fees from EBR systems, outside the submitted work. SN acknowledges support from the UK Engineering and Physical Sciences Research Council (EP/M012492/1, NS/A000049/1, and EP/P01268X/1), the British Heart Foundation (PG/15/91/31812,PG/13/37/30280, SP/18/6/33805), US National Institutes of Health (NIH R01-HL152256), European Research Council (ERC PREDICT-HF 864055) and Kings Health Partners London National Institute for Health Research (NIHR) Biomedical Research Centre. JB receives research funding and/or consultation fees from Abbott, Siemens Healthcare, EBR Systems, Biosense Webster outside of the submitted work. CR receives research funding and/or consultation fees from Abbott, Medtronic, Boston Scientific, Spectranetics and MicroPort outside of the submitted work. Funding Information: The authors are supported by the Wellcome/EPSRC Centre for Medical Engineering (WT203148/Z/16/Z). ME and VM have received fellowship funding from Abbott. BS received speaker fees from EBR systems, outside the submitted work. SN acknowledges support from the UK Engineering and Physical Sciences Research Council (EP/M012492/1, NS/A000049/1, and EP/P01268X/1), the British Heart Foundation (PG/15/91/31812,PG/13/37/30280, SP/18/6/33805), US National Institutes of Health (NIH R01-HL152256), European Research Council (ERC PREDICT-HF 864055) and Kings Health Partners London National Institute for Health Research (NIHR) Biomedical Research Centre. JB receives research funding and/or consultation fees from Abbott, Siemens Healthcare, EBR Systems, Biosense Webster outside of the submitted work. CR receives research funding and/or consultation fees from Abbott, Medtronic, Boston Scientific, Spectranetics and MicroPort outside of the submitted work. Publisher Copyright: Copyright {\textcopyright} 2022 Wijesuriya, Elliott, Mehta, Sidhu, Strocchi, Behar, Niederer and Rinaldi.",

year = "2022",

month = jun,

day = "6",

doi = "10.3389/fphys.2022.898866",

language = "English",

volume = "13",

journal = "Frontiers in Physiology",

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T1 - Leadless Left Bundle Branch Area Pacing in Cardiac Resynchronisation Therapy

T2 - Advances, Challenges and Future Directions

AU - Wijesuriya, Nadeev

AU - Elliott, Mark K.

AU - Mehta, Vishal

AU - Sidhu, Baldeep S.

AU - Strocchi, Marina

AU - Behar, Jonathan M.

AU - Niederer, Steven

AU - Rinaldi, Christopher A.

N1 - Funding Information: The authors are supported by the Wellcome/EPSRC Centre for Medical Engineering (WT203148/Z/16/Z). ME and VM have received fellowship funding from Abbott. BS received speaker fees from EBR systems, outside the submitted work. SN acknowledges support from the UK Engineering and Physical Sciences Research Council (EP/M012492/1, NS/A000049/1, and EP/P01268X/1), the British Heart Foundation (PG/15/91/31812,PG/13/37/30280, SP/18/6/33805), US National Institutes of Health (NIH R01-HL152256), European Research Council (ERC PREDICT-HF 864055) and Kings Health Partners London National Institute for Health Research (NIHR) Biomedical Research Centre. JB receives research funding and/or consultation fees from Abbott, Siemens Healthcare, EBR Systems, Biosense Webster outside of the submitted work. CR receives research funding and/or consultation fees from Abbott, Medtronic, Boston Scientific, Spectranetics and MicroPort outside of the submitted work. Funding Information: The authors are supported by the Wellcome/EPSRC Centre for Medical Engineering (WT203148/Z/16/Z). ME and VM have received fellowship funding from Abbott. BS received speaker fees from EBR systems, outside the submitted work. SN acknowledges support from the UK Engineering and Physical Sciences Research Council (EP/M012492/1, NS/A000049/1, and EP/P01268X/1), the British Heart Foundation (PG/15/91/31812,PG/13/37/30280, SP/18/6/33805), US National Institutes of Health (NIH R01-HL152256), European Research Council (ERC PREDICT-HF 864055) and Kings Health Partners London National Institute for Health Research (NIHR) Biomedical Research Centre. JB receives research funding and/or consultation fees from Abbott, Siemens Healthcare, EBR Systems, Biosense Webster outside of the submitted work. CR receives research funding and/or consultation fees from Abbott, Medtronic, Boston Scientific, Spectranetics and MicroPort outside of the submitted work. Publisher Copyright: Copyright © 2022 Wijesuriya, Elliott, Mehta, Sidhu, Strocchi, Behar, Niederer and Rinaldi.

PY - 2022/6/6

Y1 - 2022/6/6

N2 - 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.

AB - 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.

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U2 - 10.3389/fphys.2022.898866

DO - 10.3389/fphys.2022.898866

M3 - Article

SN - 1664-042X

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JO - Frontiers in Physiology

JF - Frontiers in Physiology

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

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