Closed-Loop Stimulation in Left Bundle Branch Area Pacing

Closed-Loop Stimulation Combined With Left Bundle Branch Area Pacing in Patients With Atrioventricular Conduction Disorders

This prospective, single-center, crossover study evaluated the effects of closed-loop stimulation (CLS) compared with conventional accelerometer-based rate-adaptive pacing (VVIR) in patients with permanent atrial fibrillation undergoing left bundle branch area pacing (LBBAP). Chronotropic responses were evaluated during standardized mental and physical stress testing. Heart rate distribution during daily activity, functional capacity, quality of life, and device-related parameters were also assessed.

Inclusion Criteria:

• Age ≥18 years
• Permanent atrial fibrillation
• Chronotropic incompetence
• Permanent pacemaker with left bundle branch area pacing (LBBAP)
• Ventricular pacing burden >50%
• Ability to provide written informed consent

Exclusion Criteria:

• Age <18 years
• Inability or unwillingness to provide informed consent