Document Type

Article

Department

Internal Medicine (East Africa)

Abstract

Background: Left Bundle Area Pacing (LBAP) is a promising alternative to conventional cardiac resynchronization therapy. There is a high prevalence of dilated cardiomyopathy in Africa, which is often associated with very wide QRS. However, data on LBAP outcomes in Africa are limited. Objective To evaluate the procedural and clinical outcomes of LBAP among African patients with very wide QRS durations.

Methods: The Multicenter African Cardiac Outcomes in Pacing (MACOP) registry enrolled 311 patients in Kenya and South Africa who underwent LBAP between 2021 and 2024. We evaluated procedural and clinical outcomes. Patients were stratified by baseline QRSd (normal < 120ms, wide 120 – 159ms, and very wide ≥160ms) and conduction abnormalities (LBBB vs. non-LBBB).

Results: The mean age was 65 years, with 46% female. The median follow-up was 6.34 months. Patients with very wide QRSd (N=96) were younger (61 years) compared to those with wide QRSd (64 years) and normal QRSd (67 years), p< 0.01. They also had higher fluoroscopy times (12min vs. 10.8min vs. 7.1min), p< 0.01. A higher percentage of patients with very wide QRS had LVEF < 50% (90%) compared to the other groups (67% and 27%), p< 0.01. Post-implant QRS duration was highest in the very wide QRS group (124.3ms vs. 119.3ms and 113.1ms respectively, p< 0.01).

Conclusion: Patients in this African cohort undergoing LBAP with very wide QRS durations tended to be younger, had longer fluoroscopy times, lower LVEF, and higher post-implant QRS durations. These findings highlight specific considerations for LBAP in patients with very wide QRS in an African context.

Publication (Name of Journal)

Heart Rhythm O2

DOI

https://doi.org/10.1016/j.hroo.2025.08.011

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