Safety and Feasibility of AutoCaptureTM Pacing System in Patients undergoing LBBAP

Abstract Background The AutoCapture™ Pacing algorithm enhances safety and enables remote monitoring in conventional pacing; however, its application for permanent His bundle pacing has been limited. Left bundle branch area pacing (LBBAP) is a novel technique, and there is limited data on the application of the AutoCapture algorithm. Methods The prospective cohort at our University Hospital, South Korea, included all patients underwent LBBAP from 2022 to 2023. Patients were divided into two groups based on whether the AutoCapture algorithm was activated, with follow-ups every 3–6 months to evaluate clinical adverse events, including mortality, hospitalization, syncope, and loss of capture. Results A total of 97 patients (39 men, 75.2 ± 11.2 years) were divided into AutoCapture (n=47) and Manual (n=50) groups. R-wave amplitudes, pacing thresholds, and impedance values were similar between the groups. Over a 12 months period, LBBAP thresholds remained stable, and no adverse events were observed in the AutoCapture group. One patient in the Manual group experienced syncope due to capture loss caused by retraction of helix. Pacing output was significantly lower in the AutoCapture group (1.1 ± 0.3 vs. 2.00 ± 0.51, p < 0.001), enabling selective LBBAP. Conclusion The AutoCapture algorithm is safe and feasible for patients undergoing LBBAP, enabling lower pacing output and selective LBBAP.Scheme of the study protocol  Representative case