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.