Left Bundle Branch Area Pacing

After nearly 3 years with permanent afib and the clinicians decision not to atempt to restore sinus rhythm due to age (81) and heart damage due to MI in 2006 I have not been happy having to live with much reduced exertion tolerance and no exercise tolerance. I have been a life long runner and other sports, plus 25 years Army service where exercise was mandatory not optional, so inactivity does not sit well with me. In April it was decided to upgrade my dual chamber pm to biventricular but after 3 hours the clinician could not place the 3rd lead. In June another attempt was made but this time with Left Bundle Branch Area Pacing and after 3 hours this was successful. No immediate results but after 3 weeks my energy levels increased substantially, breathing and moving (walking speed) was much easier and sustained endurance time increased. Happy bunny with that.. My Cardiologist says that more QOL can be obtained via AV Node ablation but i need a bit of time to get my head around that. In the meantime I'm comfortable with the gains made by LBBA pacing, but I am still on high dose toxic medication. 


3 Comments

Glad you are happy with your upgrade

by Gemita - 2022-08-08 05:54:27

Caratacus, many thanks for the update and I am delighted to hear of your partial success with your upgrade to a biventricular pacemaker.  I agree to allowing a bit more time to get your head around to having an AV Node ablation since you are finding your current upgrade so helpful.  I would work with that too, to optimise the settings first, then reassess.

I suppose the immediate benefit of an AV Node ablation would be the possibility to come off high dose, toxic meds and to get some respite from your atrial tachy arrhythmias, since these would no longer be able to pass through your AV Node to push your ventricles so fast or cause troublesome symptoms.  Of course this would come at the cost of destroying your AV Node, so a very big decision.   Good luck 

Left Bundle Branch Area Pacing

by Caratacus - 2022-08-08 08:22:55

Thanks Gemita. I'm no expert but i believe there is growing support for left bundle branch area pacing as it relies on the hearts natural conduction system whereas biventricular is mechanical pacing ie the 3rd lead is plugged into the left ventricle. My cardiologist is in no rush to seal off the av node so I will let this latest pacing procedure settle down Coming off BB's, Ace inhibitors and digoxin is attractive though. 

Left Bundle Branch Area Pacing

by Gemita - 2022-08-08 09:18:19

Caratacus,

Yes you have certainly received the latest physiological pacing in the left bundle branch area that guarantees electrical synchrony of the left ventricle with a low pacing threshold.  This appears (please see link)  equally as good if not better than His bundle pacing because of the challenges with HIS bundle placement, high pacing capture threshold and early battery depletion.

If you are feeling better already, left bundle branch area pacing could well turn out to be all that you will need to improve your quality of life in the short term and you might even find with improvements in pacing, you will need less in the way of medication anyway.  I really hope so.  Please let us know how you progress.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021709/

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I just want to share about the quality of life after my pacemaker, and hopefully increase awareness that lifestyles do not have to be drastically modified just because we are pacemaker recipients.