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Related Experiment Video

Updated: Dec 20, 2025

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Left bundle branch area. A new site for physiological pacing: a pilot study.

Asit Das1, Sk Sahidul Islam2, Sushant Kumar Pathak2

  • 1Department of Cardiology, IPGME&R and SSKM Hospital, 244, AJC Bose Road, Kolkata, 700020, India. dradascard@rediffmail.com.

Heart and Vessels
|May 28, 2020
PubMed
Summary

Left bundle branch area pacing offers a more physiological alternative to conventional right ventricular pacing, improving left ventricular function and shortening QRS duration. This technique may be a viable option for patients needing significant ventricular pacing.

Keywords:
His bundle pacingLeft bundle branch area pacingPhysiological pacing

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Chronic right ventricular (RV) pacing can lead to pacing-induced cardiomyopathy, increasing risks of left ventricular (LV) systolic dysfunction, heart failure, mitral regurgitation, and atrial fibrillation.
  • His bundle pacing is a physiologic alternative, but its adoption is limited by implantation challenges and lead performance issues.
  • Left bundle branch area pacing (LBBAP) has emerged as a potential solution to overcome the limitations of RV pacing and His bundle pacing.

Purpose of the Study:

  • To compare the efficacy and short-term outcomes of LBBAP versus conventional RV apical pacing (RVAP).
  • To evaluate procedure time, fluoroscopy time, lead performance, and left ventricular function between LBBAP and RVAP.

Main Methods:

  • A comparative study involving 22 patients undergoing LBBAP and 28 patients undergoing RVAP for pacemaker implantation.
  • Assessment of procedural parameters, fluoroscopy duration, lead performance metrics, and echocardiographic evaluation of left ventricular function.

Main Results:

  • LBBAP resulted in significantly shortened QRS duration (22.36 ± 9.36 ms) compared to RVAP.
  • Patients receiving LBBAP demonstrated improved left ventricular function, evidenced by higher ejection fraction (64.00 ± 3.03% vs. 59.73 ± 6.73%) and lower LV internal diastolic diameter (4.58 ± 0.32 cm vs. 5.23 ± 0.40 cm).
  • Procedure and fluoroscopy times were comparable between the LBBAP and RVAP groups.

Conclusions:

  • Left bundle branch area pacing is associated with improved left ventricular function and electrical synchrony compared to conventional RV apical pacing.
  • LBBAP may serve as a promising alternative for physiological pacing, particularly in patients requiring a high percentage of ventricular pacing.
  • The study supports LBBAP as a viable option for achieving better patient outcomes in pacemaker implantation.