Discussion:
Huang et al3 in 2017 first reported LBBP as a safe alternative to HBP to provide low and stable threshold in patient with heart failure and LBBB. Though multiple studies are available5,6, there is no published data on safety of LBBP in elderly patients. In this paper we have shown that LBBP could be successfully done in 10 out of 11 patients without any procedural complication. LBBP could reduce the QRS duration from 145.9 ± 27.7ms to 107.1 ± 9.5ms (p value 0.00001). LV ejection fraction improved from 47.6 ± 11.2% to 55.9 ± 5.4% (p value 0.017) during follow up. The lead parameters remained stable during follow up (table 2). All these findings are comparable to the published studies by other authors on LBBP5,7,8
Generally, CRT trials have excluded very old patients (>80 years old) and little data exist on outcomes of CRT in elderly9. Rigot et al10, in a retrospective study showed that the response to CRT was not compromised in patients aged >75 years with 14% mortality at the end of one year. Achilli et al11 showed 2.4% LV lead dislodgement in patients aged >80 years undergoing CRT. Though similar clinical efficacy was noted as compared to those under 80 years, 17.3% mortality occurred during follow up of 12 months. LBBP could be safely done as an alternative for cardiac re-synchronization therapy in our small cohort aged ≥ 80 years. We could also show significant reduction in QRS duration along with improvement in LVEF in these patients. With the stable lead parameters and less procedural complication rate, LBBP has the potential to be an excellent alternative to CRT in elderly patients.