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

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Article number898866
JournalFrontiers in Physiology
Volume13
DOIs
Accepted/In press20 Apr 2022
Published6 Jun 2022

Bibliographical 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 © 2022 Wijesuriya, Elliott, Mehta, Sidhu, Strocchi, Behar, Niederer and Rinaldi.

Documents

King's Authors

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.

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