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Related Experiment Video

Updated: May 11, 2026

Testing the Efficacy of Pharmacological Agents in a Pericardial Target Delivery Model in the Swine
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Strain-based evaluation of septal function after left bundle branch area pacing.

Emine Özpak1, Thomas Van Overmeiren1, Simon Calle1

  • 1Department of Cardiology, Ghent University Hospital, Ghent, Belgium.

Heart Rhythm
|August 31, 2025
PubMed
Summary

Deep septal lead placement for Left Bundle Branch Area Pacing (LBBAP) generally preserves septal contractility. However, specific ECG findings may indicate abnormal septal contraction patterns post-implantation.

Keywords:
Cardiac pacingConduction system pacingLeft bundle branch area pacingSeptal contractilitySeptal contraction patternStrain assessment or strain echocardiogaphyStrain measurement

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Pacing

Background:

  • Left Bundle Branch Area Pacing (LBBAP) involves deep septal lead implantation.
  • The effect of this deep lead placement on septal contractility is not fully understood.

Purpose of the Study:

  • To assess the impact of deep septal lead deployment in LBBAP on septal contraction and activation sequence.
  • To evaluate changes in septal strain and identify contraction patterns during pacing.

Main Methods:

  • Prospective analysis of 84 adult patients undergoing LBBAP.
  • Strain imaging (GLS, PSS) pre- and post-implantation, during intrinsic rhythm and VVI pacing.
  • Assessment of septal strain curves and identification of contraction patterns.

Main Results:

  • No significant change in intrinsic Peak Septal Strain (PSS) in patients with normal baseline function.
  • Significant improvement in PSS for patients with reduced baseline septal function post-LBBAP.
  • Four septal contraction patterns identified during VVI pacing; higher scores correlated with discoordinated activation and reduced ventricular function.
  • Absence of a terminal R' wave in lead V1 predicted discoordinated septal contraction.

Conclusions:

  • Deep septal lead placement for LBBAP typically does not impair mid-term septal contractility.
  • Most patients maintain normal septal contraction patterns (I & II) after LBBAP.
  • Absence of R' wave in lead V1 is associated with abnormal septal contraction and may impact LBBAP outcomes.