Evaluation of the Feasibility and Safety of Left Ventricular Pacing Using Left Bundle Branch Area Pacing (LBBAP) Without Backup Right Ventricular Pacing Lead

All articles of this category (opens in new window) Background: This study aims to evaluate the feasibility and safety of sole left ventricular pacing using left bundle branch area pacing (LBBAP) without a backup right ventricular lead. Methods: Patients who were over 18 years old and received a pacemaker with left bundle branch area pacing (LBBAP) with no additional right ventricular lead implantation from June 2023 through October 2024 in a single center were included. Patients with incomplete documentation and those who failed to provide informed consent were excluded. Preoperative, intraoperative, and postoperative data were retrospectively collected. A prospective follow-up with determination of changes in Rheobase, lead impedance, and sensing (postoperatively, at 6 weeks, and at 6 months) was documented, as well as lead dislocation or pacemaker-related complications. NT-pro-BNP values were evaluated 6 months after implantation. Results: A total of 42 patients were included, with a mean age of 77 ± 10 years, 68% males, 83% in sinus rhythm, mean EF of 54 ± 7%. The main indication was a third-degree AV-Block (34%), bradycardia-tachycardia syndrome (24%) sick sinus syndrome (24%). The mean operative time was 60 ± 10 minutes. The mean radiation dose was 1,103 ± 561 (cGy) cm 2 The LBBAP QRS time was 112 ms. Three patients suffered a postoperative hematoma and were treated conservatively. Two patients suffered a dislocation of the LBBA lead, and they were repositioned. During follow-up, one patient died of pneumonia. The follow-up data were complete for the remaining 41 patients. There were no late dislocations or pacemaker-related complications. The Rheobase significantly increased from a mean of 0.55 mV after implantation to 0.82 mV after 6 weeks ( p < 0.001) and did not change significantly after 6 months (0.82 vs. 0.69 mV, respectively, p > 0.999). The mean electrode impedance improved significantly after 6 weeks (391 vs. 469 Ohm perioperatively, p = 0.02) and did not change significantly after 6 months. The sensing did not change significantly over time (11.8 vs. 12.3 vs. 12.2 mV; p = 0.085). The NT-proBNP did not change significantly over 6 months (1,422 vs. 2,001 pg/mL ; p = 0.764). Conclusion: LBBAP is a safe and stable approach that provides a more physiological pacing. The pacing electrodes are stable, their parameters stay stable over time, and a dislocation is only seen perioperatively. A backup right ventricular lead may not be needed with increased experience, yet longer perioperative monitoring might be warranted to exclude perioperative dislocation. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany