New highly specialised pacemaker procedure is a Scottish first for NHS Fife

It has been introduced by NHS Fife and allows residents here the chance to be treated much closure to home. The work also underlines the regional health board’s position as a national leader in advanced cardiac pacing.

The procedure is the Left Bundle Optimised Cardiac Resynchronisation Therapy (LOT‑CRT), a highly specialised form of cardiac resynchronisation therapy designed for selected patients with heart failure.

Cardiac pacing is a treatment used for people whose hearts do not beat in a regular or coordinated way. This typically involves a pacemaker being implanted under the skin, which sends electrical signals to help control the heart’s rhythm and ensure it beats effectively.

For people with heart failure, more advanced forms of pacing can help the heart’s chambers work together more efficiently, reducing symptoms and improving quality of life.

The cardiology team in Fife has developed significant expertise in the use of Left Bundle Branch Area Pacing (LBBAP) - an advanced pacing technique that more closely mimics the heart’s natural electrical activation. NHS Fife was the first health board in Scotland to adopt the procedure in 2022.

Building on this experience, the team has now introduced LOT‑CRT, a highly specialised form of cardiac resynchronisation therapy designed for selected patients with heart failure.

It involves very precisely placing pacing leads in both lower pumping chambers of the heart, and in the left bundle branch area, which is part of the organ’s natural electrical conduction system, helping the heart to beat in a more natural and coordinated way. This helps the heart’s chambers beat together more efficiently, reducing strain on the heart muscle and reducing symptoms for people with heart failure.

This development ensures that advanced technical capabilities -typically found only in much larger city hospitals -remain available within a district general hospital in Fife. It also means patients who would have been referred to specialist centres outwith the area can now be cared for much closer to home, while still benefiting from cutting‑edge cardiac care.

Dr Jagdeep Singh, consultant cardiologist at NHS Fife, said: “Advanced pacing techniques such as left bundle branch area pacing and LOT‑CRT are complex and technically demanding, but they can offer significant benefits for selected patients with heart failure.

“We began delivering left bundle branch pacing in Fife in 2022 and have continued to develop and refine our approach as the evidence and techniques have evolved. Introducing LOT‑CRT builds on that experience and reflects the depth of expertise within our team.

“While other centres in Scotland are now beginning to adopt these techniques, being able to offer them locally in Fife demonstrates the skill, dedication and teamwork of the cardiology service and allows patients to access highly specialised treatment much closer to home.”

The continued development of advanced cardiac pacing techniques forms part of NHS Fife’s wider commitment to delivering specialist services locally, ensuring patients benefit from innovation while maintaining high standards of safety, quality and clinical governance.