Left bundle branch area pacing outcomes from an African registry: Short-term findings from the MACOP study

Background Left bundle branch area pacing (LBBAP) provides physiological ventricular activation and has emerged as an alternative to conventional cardiac resynchronization therapy. Data on LBBAP outcomes in African populations remain scarce. Objective This study aimed to describe procedural outcomes of LBBAP in an African cohort. Methods A descriptive registry study included 311 patients from Kenya and South Africa who underwent LBBAP between 2021 and 2024. Data on pacing thresholds, QRS duration (QRSd), fluoroscopy time, and left ventricular ejection fraction (LVEF) were collected and analyzed. Patients were stratified by baseline QRSd categories, conduction patterns, pacing indication, and LVEF. Results The mean age was 65 ± 14 years, with 54% male. Median follow-up was 5 months. Mean pacing threshold at implant was 0.67 ± 0.52 V at 1.0 ms, remaining stable at follow-up (0.64 ± 0.48 V, P = .3). Mean QRSd decreased significantly from 136.7 ± 33.6 ms at baseline to 118.4 ± 12.0 ms post-LBBAP ( P < .001), with greatest reduction in patients with left bundle branch block (LBBB: 38.9 ± 16.9 ms vs non-LBBB: 6.9 ± 30.2 ms, P < .001). Mean fluoroscopy time was 9.7 ± 7.8 minutes. Among patients with baseline LVEF <50%, mean LVEF improved from 29 ± 9% to 39 ± 12% ( P < .001), with greater improvement in patients with LBBB. Procedural success rate was 95.8%. During follow-up, 12 patients (3.86%) died, all from heart failure–related causes without documented ventricular arrhythmias on device interrogation. Conclusion The Multicenter African Cardiac Outcomes in Pacing study provides the first African registry data on LBBAP, demonstrating feasibility with stable pacing thresholds, significant QRS narrowing, and LVEF improvement, particularly in patients with LBBB. These findings support LBBAP as a viable pacing strategy in resource-limited settings.