Scientific article
Open access

Left bundle branch area pacing outcomes : the multicentre European MELOS study

Published inEuropean heart journal, vol. 43, no. 40, p. 4161-4173
Publication date2022-10-21
First online date2022-08-18


Permanent transseptal left bundle branch area pacing (LBBAP) is a promising new pacing method for both bradyarrhythmia and heart failure indications. However, data regarding safety, feasibility and capture type are limited to relatively small, usually single centre studies. In this large multicentre international collaboration, outcomes of LBBAP were evaluated.

Methods and results

This is a registry-based observational study that included patients in whom LBBAP device implantation was attempted at 14 European centres, for any indication. The study comprised 2533 patients (mean age 73.9 years, female 57.6%, heart failure 27.5%). LBBAP lead implantation success rate for bradyarrhythmia and heart failure indications was 92.4% and 82.2%, respectively. The learning curve was steepest for the initial 110 cases and plateaued after 250 cases. Independent predictors of LBBAP lead implantation failure were heart failure, broad baseline QRS and left ventricular end-diastolic diameter. The predominant LBBAP capture type was left bundle fascicular capture (69.5%), followed by left ventricular septal capture (21.5%) and proximal left bundle branch capture (9%). Capture threshold (0.77 V) and sensing (10.6 mV) were stable during mean follow-up of 6.4 months. The complication rate was 11.7%. Complications specific to the ventricular transseptal route of the pacing lead occurred in 209 patients (8.3%).


LBBAP is feasible as a primary pacing technique for both bradyarrhythmia and heart failure indications. Success rate in heart failure patients and safety need to be improved. For wider use of LBBAP, randomized trials are necessary to assess clinical outcomes.

  • Complications
  • Conduction system pacing
  • Distal capture
  • Left bundle branch pacing
  • Left bundle fascicular pacing
  • Left ventricular septal pacing
Citation (ISO format)
JASTRZĘBSKI, Marek et al. Left bundle branch area pacing outcomes : the multicentre European MELOS study. In: European heart journal, 2022, vol. 43, n° 40, p. 4161–4173. doi: 10.1093/eurheartj/ehac445
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Article (Published version)
ISSN of the journal0195-668X

Technical informations

Creation10/19/2023 2:20:02 PM
First validation02/28/2024 10:38:14 AM
Update time02/28/2024 10:38:14 AM
Status update02/28/2024 10:38:14 AM
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