New pacemaker surgery available in East Kent

Dr Idris Harding now offers a new sort of pacemaker surgery to treat patients with bradycardia (slow heartbeat). Patients in East Kent will be among the first to benefit from this pioneering new treatment.

Left bundle branch area pacemaker surgery (LBBAP) was developed at Hammersmith Hospital to tackle the problem of pacemakers causing the heart muscle to weaken over time. This issue, called “Pacing induced cardiomyopathy” is a cause of heart failure in patients living with a pacemaker.

For patients with heart block, pacemaker surgery can be life-saving. These devices literally keep the heartbeat going for most patients. However, a small proportion of people fitted with a pacemaker may later develop heart failure. This sting in the tail is called “pacing induced cardiomyopathy”, and may develop months or even years after pacemaker surgery. People who benefit most from pacemaker surgery are most at risk of pacing induced cardiomyopathy in the longer term.

The problem is that most pacemaker surgery triggers the lower chambers of the heart (“ventricles”) in a very artificial sequence. Over time, this seems to lead to poor coordination of the heart muscle pump function (so-called “dyssynchrony”) in some people. Left bundle branch pacing minimises dyssynchrony by wiring a pacemaker lead directly into the heart’s own electrical system. Beats caused by a LBBAP pacemaker spread through the heart the same way as a normal heart beat. This avoids dyssynchrony and reduces the risk of heart failure.

Alternatives to left bundle pacemaker surgery

Other pacemaker surgery techniques for minimising dyssynchony exist. However, unlike LBBAP, treatments such as Cardiac Resynchronisation Therapy (CRT) require extra leads in the heart. This in turn raises the risk of other problems. LBBAP uses the exact same kit as a conventional pacemaker, but placed in a much more precise way. The procedure is only slightly longer than a conventional pacemaker and has the potential to revolutionise cardiac pacing.

Clinical trials

Many clinical trials are currently running, examining the safety profile and success rate of this promising new pacemaker surgery treatment for bradycardia. We are particularly keen to know which patients benefit most from LBBAP surgery and anticipate recruiting to these trials soon!