{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T15:17:40Z","timestamp":1773760660387,"version":"3.50.1"},"reference-count":57,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Resynchronization therapy has become a cornerstone in patients with heart failure (HF). Recent advancements in this field have led to the development of the so-called \u201cleft bundle branch area pacing\u201d (LBBAP), a form of pacing where a single ventricular catheter directly addresses the left bundle for a more physiological stimulation. The current literature provides encouraging evidence regarding this topic, but there is still limited data for the older population, particularly those aged \u226575 years. This review aims to clarify how LBBAP has been explored in this cohort and if its application could be safe and effective even in the most advanced stages of life. Methods: A search of articles from PubMed was conducted. Patients were considered older if above 75 years of age. Data regarding Italian statistics were obtained from national registries. Results: The current literature supports the safety and effectiveness of LBBAP in older patients across different indications, with outcomes comparable to those reported in younger patients and a suggested cost-effectiveness. Conversely, data regarding patients affected by cardiac amyloidosis are still inconclusive. Conclusions: LBBAP represents a valuable resource for patients of all ages, but frailty is a major issue in the older population that needs to be addressed. The potential integration of this technology with defibrillator capabilities will enable an even more extensive application in the near future.<\/jats:p>","DOI":"10.3390\/life16030490","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T12:42:16Z","timestamp":1773751336000},"page":"490","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Left Bundle Branch Area Pacing in Older Patients: A New Opportunity?"],"prefix":"10.3390","volume":"16","author":[{"given":"Michele","family":"Alfieri","sequence":"first","affiliation":[{"name":"Cardiology and Cardiac Intensive Care Unit, The Department of Clinical, Special and Dental Sciences, IRCCS, INRCA, 60127 Ancona, Italy"},{"name":"The Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60131 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenzo","family":"Pimpini","sequence":"additional","affiliation":[{"name":"Cardiology and Cardiac Intensive Care Unit, The Department of Clinical, Special and Dental Sciences, IRCCS, INRCA, 60127 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filippo","family":"Pirani","sequence":"additional","affiliation":[{"name":"Cardiology and Cardiac Intensive Care Unit, The Department of Clinical, Special and Dental Sciences, IRCCS, INRCA, 60127 Ancona, Italy"},{"name":"The Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60131 Ancona, Italy"},{"name":"Arrhythmology and Cardiology Clinic, Marche Regional Hospital, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniele","family":"Caraceni","sequence":"additional","affiliation":[{"name":"Cardiology and Cardiac Intensive Care Unit, The Department of Clinical, Special and Dental Sciences, IRCCS, INRCA, 60127 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1840-3903","authenticated-orcid":false,"given":"Giulia","family":"Matacchione","sequence":"additional","affiliation":[{"name":"Clinic of Laboratory and Precision Medicine, IRCCS INRCA, 60127 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5394-1312","authenticated-orcid":false,"given":"Federico","family":"Guerra","sequence":"additional","affiliation":[{"name":"Cardiology and Cardiac Intensive Care Unit, The Department of Clinical, Special and Dental Sciences, IRCCS, INRCA, 60127 Ancona, Italy"},{"name":"The Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60131 Ancona, Italy"},{"name":"Arrhythmology and Cardiology Clinic, Marche Regional Hospital, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5322-1742","authenticated-orcid":false,"given":"Michela","family":"Casella","sequence":"additional","affiliation":[{"name":"The Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60131 Ancona, Italy"},{"name":"Arrhythmology and Cardiology Clinic, Marche Regional Hospital, 60126 Ancona, Italy"},{"name":"Department of Clinical, Special and Dental Sciences, Polytechnic University of Marche, 60131 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Antonicelli","sequence":"additional","affiliation":[{"name":"Cardiology and Cardiac Intensive Care Unit, The Department of Clinical, Special and Dental Sciences, IRCCS, INRCA, 60127 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.hfc.2021.05.005","article-title":"Cardiac Resynchronization Therapy and Cardiac Contractility Modulation in Patients with Advanced Heart Failure: How to Select the Right Candidate?","volume":"17","author":"Abraham","year":"2021","journal-title":"Heart Fail. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Alfieri, M., Bruscoli, F., Di Vito, L., Di Giusto, F., Scalone, G., Marchese, P., Delfino, D., Silenzi, S., Martoni, M., and Guerra, F. (2024). Novel Medical Treatments and Devices for the Management of Heart Failure with Reduced Ejection Fraction. J. Cardiovasc. Dev. Dis., 11.","DOI":"10.20944\/preprints202403.1790.v1"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1016\/j.jacc.2009.06.006","article-title":"The effects of right ventricular apical pacing on ventricular function and dyssynchrony implications for therapy","volume":"54","author":"Tops","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2289","DOI":"10.1007\/s11357-023-00739-z","article-title":"Long-term outcome of cardiac resynchronization therapy patients in the elderly","volume":"45","author":"Behon","year":"2023","journal-title":"Geroscience"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1161\/CIRCOUTCOMES.113.000821","article-title":"Left ventricular reverse remodeling, device-related adverse events, and long-term outcome after cardiac resynchronization therapy in the elderly","volume":"7","author":"Putter","year":"2014","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1016\/j.cardfail.2016.09.023","article-title":"Mode of Death in Octogenarians Treated with Cardiac Resynchronization Therapy","volume":"22","author":"Martens","year":"2016","journal-title":"J. Card. Fail."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.cardfail.2021.10.013","article-title":"Comparative effectiveness of cardiac resynchronization therapy in older patients with heart failure: Systematic review and meta-analysis","volume":"28","author":"Juggan","year":"2022","journal-title":"J. Card. Fail."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1016\/j.jacep.2017.06.012","article-title":"Utility of Frailty Assessment for Elderly Patients Undergoing Cardiac Resynchronization Therapy","volume":"3","author":"Kubala","year":"2017","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3427","DOI":"10.1093\/eurheartj\/ehab364","article-title":"2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC) with the special contribution of the European Heart Rhythm Association (EHRA)","volume":"42","author":"Glikson","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"27","DOI":"10.3143\/geriatrics.43.27","article-title":"Reviewing the definition of elderly","volume":"43","author":"Orimo","year":"2006","journal-title":"Nihon Ronen Igakkai Zasshi"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"45","DOI":"10.2174\/011573403X276647240217112151","article-title":"Systematic Review of the Association of the Hospital Frailty Risk Score with Mortality in Patients with Cerebrovascular and Cardiovascular Disease","volume":"20","author":"Sokhal","year":"2024","journal-title":"Curr. Cardiol. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"iii126","DOI":"10.1093\/eurheartjsupp\/suaf030","article-title":"The advantages of physiological pacing","volume":"27","author":"Finamora","year":"2025","journal-title":"Eur. Heart J. Suppl."},{"key":"ref_14","first-page":"1208","article-title":"EHRA clinical consensus statement on conduction system pacing implantation: Endorsed by the Asia Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS), and Latin American Heart Rhythm Society (LAHRS)","volume":"25","author":"Burri","year":"2023","journal-title":"EP Eur."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"452","DOI":"10.33963\/KP.a2022.0048","article-title":"Feasibility and safety of left bundle branch area pacing in very elderly patients (\u226580 years)","volume":"80","author":"Jiang","year":"2022","journal-title":"Kardiol. Pol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ren, Z., Cai, B., Wang, S., Jia, P., Chen, Y., Guo, R., Li, H., Zhang, J., Xiong, J., and Zhang, J. (2021). Feasibility and Safety of Left Bundle Branch Pacing for Advance Aged Patients: A Multicenter Comparative Study. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.661885"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Rijks, J.H.J., Lankveld, T., Manusama, R., Broers, B., van Stipdonk, A.M.W., Chaldoupi, S.M., ter Bekke, R.M.A., Schotten, U., Linz, D., and Luermans, J.G.L.M. (2023). Left Bundle Branch Area Pacing and Atrioventricular Node Ablation in a Single-Procedure Approach for Elderly Patients with Symptomatic Atrial Fibrillation. J. Clin. Med., 12.","DOI":"10.3390\/jcm12124028"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1002\/ehf2.12731","article-title":"Left bundle branch area pacing delivery of cardiac resynchronization therapy and comparison with biventricular pacing","volume":"7","author":"Li","year":"2020","journal-title":"ESC Heart Fail."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2628","DOI":"10.1016\/j.jacep.2023.08.003","article-title":"His-Purkinje Conduction System Pacing Optimized Trial of Cardiac Resynchronization Therapy vs Biventricular Pacing: HOT-CRT Clinical Trial","volume":"9","author":"Vijayaraman","year":"2023","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.jacc.2023.05.006","article-title":"Comparison of Left Bundle Branch Area Pacing and Biventricular Pacing in Candidates for Resynchronization Therapy","volume":"82","author":"Vijayaraman","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1536","DOI":"10.1111\/jce.16304","article-title":"Left bundle branch area pacing in heart failure: A systematic review and meta-analysis with meta-regression","volume":"35","author":"Golamari","year":"2024","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1007\/s10840-022-01174-4","article-title":"Feasibility and safety of left bundle branch area pacing-cardiac resynchronization therapy in elderly patients","volume":"66","author":"Grieco","year":"2023","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.ihj.2020.12.017","article-title":"Feasibility, safety and outcomes of left bundle branch pacing in octogenarians","volume":"73","author":"Ponnusamy","year":"2021","journal-title":"Indian Heart J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1111\/pace.70010","article-title":"Safety and Efficacy of Stylet-Driven Leads for Left Bundle Branch Area Pacing in Octogenarians","volume":"48","author":"Korkmaz","year":"2025","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.ipej.2025.01.001","article-title":"Conduction disease in cardiac amyloidosis patients: A case series suggesting a role for left bundle branch area pacing","volume":"25","author":"Mehta","year":"2025","journal-title":"Indian Pacing Electrophysiol. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1111\/pace.14894","article-title":"Feasibility and safety of left bundle branch area pacing in cardiac amyloidosis. A single center experience","volume":"47","year":"2024","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Leventopoulos, G., Nastouli, K.M., Bozika, M., Papastavrou, E., Apostolos, A., Koros, R., Perperis, A., Koniari, I., Vlassopoulou, N., and Chronopoulos, P. (2025). Understanding LOT-CRT: Current Insights, Limitations, and Our Center\u2019s Experience. J. Clin. Med., 14.","DOI":"10.3390\/jcm14093025"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/j.jacep.2021.04.005","article-title":"Left Bundle Branch Pacing Optimized Cardiac Resynchronization Therapy: A Novel Approach","volume":"7","author":"Vijayaraman","year":"2021","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"ytae323","DOI":"10.1093\/ehjcr\/ytae323","article-title":"Cardiac resynchronization therapy-defibrillator implantation with shock lead placement in the left bundle branch area: A case report","volume":"8","author":"Yoshida","year":"2024","journal-title":"Eur. Heart J. Case Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.hrthm.2021.08.033","article-title":"Clinical outcomes of left bundle branch area pacing compared to right ventricular pacing: Results from the Geisinger-Rush Conduction System Pacing Registry","volume":"19","author":"Sharma","year":"2022","journal-title":"Heart Rhythm."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1016\/j.hroo.2025.03.015","article-title":"Evaluation of cardiac energetics in left bundle branch area pacing using noninvasive pressure-volume loops","volume":"6","author":"Inoue","year":"2025","journal-title":"Heart Rhythm. O2"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1111\/pace.15056","article-title":"Comparison of clinical and echocardiographic outcomes between left bundle branch area pacing and right ventricular pacing in older patients","volume":"47","author":"Wang","year":"2024","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s10840-024-01890-z","article-title":"Mid-term clinical outcomes of left bundle branch area pacing compared to accurate right ventricular septal pacing","volume":"68","author":"Okubo","year":"2025","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1111\/pace.70028","article-title":"Left Bundle Branch Area Pacing After Transcatheter Aortic Valve Implantation. A Single Center Experience","volume":"48","author":"Oteo","year":"2025","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1111\/pace.14707","article-title":"Left bundle branch area pacing prevents pacing induced cardiomyopathy in long-term observation","volume":"46","author":"Bednarek","year":"2023","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Jastrz\u0119bski, M., Kie\u0142basa, G., Cano, O., Curila, K., Zanon, F., Pestrea, C., De Pooter, J., Luermans, J., Rademakers, L.M., and \u017di\u017eek, D. (2025). Left bundle branch area pacing vs right ventricular pacing for atrioventricular block: The MELOS RELOADED study. Eur. Heart J, ehaf699.","DOI":"10.1093\/eurheartj\/ehaf699"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1093\/europace\/euv268","article-title":"The risk of atrial fibrillation during right ventricular pacing","volume":"18","author":"Pastore","year":"2016","journal-title":"Europace"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Wang, Z., Zhu, H., Li, X., Yao, Y., Liu, Z., and Fan, X. (2021). Comparison of Procedure and Fluoroscopy Time Between Left Bundle Branch Area Pacing and Right Ventricular Pacing for Bradycardia: The Learning Curve for the Novel Pacing Strategy. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.695531"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1007\/s10840-023-01620-x","article-title":"Difference of ventricular synchrony between LBBP, LBFP and LVSP: A speckle tracking echocardiographic study","volume":"67","author":"Cheng","year":"2024","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.hrthm.2025.04.035","article-title":"Hierarchical physiologic pacing to enhance clinical outcomes in conduction system pacing","volume":"23","author":"Ponnusamy","year":"2026","journal-title":"Heart Rhythm."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e70116","DOI":"10.1002\/clc.70116","article-title":"Long-Term Effects of Left Bundle Branch Area Pacing Versus Traditional Right Ventricular Pacing on Atrial Fibrillation After Dual-Chamber Pacemaker Implantation","volume":"48","author":"Chen","year":"2025","journal-title":"Clin. Cardiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.ijcard.2010.12.075","article-title":"Left atrial remodeling and reduced atrial pump function after chronic right ventricular apical pacing in patients with preserved ejection fraction","volume":"157","author":"Xie","year":"2012","journal-title":"Int. J. Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): Developed by the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC), with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Endorsed by the European Stroke Organisation (ESO)","volume":"45","author":"Rienstra","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1111\/pace.15077","article-title":"Cost-Effectiveness Ratio Analysis of LBBaP Versus BVP in Heart Failure Patients with LBBB","volume":"47","author":"Wang","year":"2024","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_45","first-page":"94","article-title":"Scompenso cardiaco e impatto economico: Un\u2019analisi nella reale pratica clinica in Italia","volume":"11","author":"Dovizio","year":"2024","journal-title":"Glob. Reg. Health Technol. Assess."},{"key":"ref_46","first-page":"30","article-title":"Pacemaker e defibrillatori impiantabili in Italia: Analisi delle schede di dimissione ospedaliera nazionali 2001\u20132023 con focus sul volume di attivit\u00e0 delle strutture e sulla mobilit\u00e0 interregionale","volume":"5","author":"Ciminello","year":"2025","journal-title":"Boll. Epidemiol. Naz."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"4161","DOI":"10.1093\/eurheartj\/ehac445","article-title":"Left bundle branch area pacing outcomes: The multicentre European MELOS study","volume":"43","author":"Cano","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"108876","DOI":"10.1016\/j.cmpb.2025.108876","article-title":"Virtual cardiac histology: Towards a radiodensitometric characterization of left ventricular cardiac muscle in healthy and pathological conditions","volume":"269","author":"Forni","year":"2025","journal-title":"Comput. Methods Programs Biomed."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e388","DOI":"10.1016\/j.hrthm.2025.03.1982","article-title":"Outcome of septal vascular injury and perforation in left bundle branch area pacing: Evaluating septal integrity using an institutional protocol","volume":"22","author":"Tournoy","year":"2025","journal-title":"Heart Rhythm."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"euae130","DOI":"10.1093\/europace\/euae130","article-title":"Current of injury amplitude during left bundle branch area pacing implantation: Impact of filter settings, ventricular pacing, and lead type","volume":"26","author":"Burri","year":"2024","journal-title":"Europace"},{"key":"ref_51","first-page":"45","article-title":"The impact of frailty on the prognosis of chronic heart failure patients treated with cardiac resynchronization therapy defibrillator implantation","volume":"64","author":"Gao","year":"2025","journal-title":"Zhonghua Nei Ke Za Zhi"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2671","DOI":"10.1007\/s11357-023-01023-w","article-title":"The prevalence of frailty and its effect on the outcome in cardiac resynchronization therapy patients","volume":"46","author":"Kuthi","year":"2024","journal-title":"Geroscience"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1016\/j.amjcard.2019.12.049","article-title":"Utility of the Modified Frailty Index to Predict Cardiac Resynchronization Therapy Outcomes and Response","volume":"125","author":"Milner","year":"2020","journal-title":"Am. J. Cardiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e010185","DOI":"10.1161\/CIRCEP.121.010185","article-title":"Frailty as a Predictor of Device Choice and Mortality in Older Cardiac Resynchronization Therapy Recipients","volume":"14","author":"Sriwattanakomen","year":"2021","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s41999-024-01112-9","article-title":"Association between frailty and adverse outcomes after cardiac resynchronization therapy: A systematic review and meta-analysis","volume":"16","author":"Li","year":"2025","journal-title":"Eur. Geriatr. Med."},{"key":"ref_56","first-page":"1857","article-title":"Simplified clinical frailty scale design, validation, and adaptation in older patients","volume":"28","author":"Nguyen","year":"2024","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Church, S., Rogers, E., Rockwood, K., and Theou, O. (2020). A scoping review of the Clinical Frailty Scale. BMC Geriatr., 20.","DOI":"10.1186\/s12877-020-01801-7"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/3\/490\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T12:59:21Z","timestamp":1773752361000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/3\/490"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,17]]},"references-count":57,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["life16030490"],"URL":"https:\/\/doi.org\/10.3390\/life16030490","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,17]]}}}