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Updated: Jun 10, 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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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 pacing for atrioventricular block and mild to moderately reduced left ventricular systolic

Hiroyuki Kato1, Toshiaki Sato2, Kenji Shimeno3

  • 1Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan.

Journal of Cardiovascular Electrophysiology
|October 17, 2024
PubMed

Insights

Left bundle branch area pacing (LBBAP) improved cardiac function in patients with atrioventricular block and reduced ejection fraction. This pacing method offers a promising alternative to biventricular pacing, enhancing heart function without fatal arrhythmias.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Pacing

Background:

  • Left bundle branch area pacing (LBBAP) efficacy is not fully understood in patients with atrioventricular block and mild to moderately reduced left ventricular ejection fraction (LVEF).
  • This study investigates the impact of LBBAP in patients with LVEF ≤50% requiring ventricular pacing.

Purpose of the Study:

  • To evaluate the clinical efficacy and echocardiographic improvements of LBBAP in patients with atrioventricular block and reduced LVEF.
  • To assess the safety of LBBAP, specifically the occurrence of fatal ventricular arrhythmias.

Main Methods:

  • Thirty-seven patients with atrioventricular block and LVEF 36%-50% underwent LBBAP.
  • Clinical outcomes and echocardiographic parameters were assessed after 1 year, with a median follow-up of 36 months.
  • Predictors of LVEF normalization were analyzed.

Main Results:

  • LBBAP successfully improved LVEF from 42.6% to 52.1% (p < .001), with 64.5% achieving normalized LVEF (>50%).
  • Eighty-nine percent of patients were free from the composite endpoint (death, fatal ventricular arrhythmias, heart failure hospitalization) during follow-up.
  • No fatal ventricular arrhythmias occurred; nonischemic cardiomyopathy and pre-existing bundle branch block predicted LVEF normalization.

Conclusions:

  • LBBAP significantly improves cardiac systolic function in patients with atrioventricular block and reduced LVEF without inducing fatal ventricular arrhythmias.
  • LBBAP presents a viable alternative to biventricular pacing for this patient population.
Abstract

Keywords:
atrioventricular blockconduction system pacingleft bundle branch area pacingleft bundle branch pacingleft ventricular septal pacingleft ventricular systolic dysfunction

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