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Autorhythmicity is a term that refers to the heart's inherent ability to generate electrical signals and instigate muscle contractions. This self-regulating conduction system within the heart consists of two key components: the pacemaker cells and specialized conducting cells.
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Updated: Jan 15, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Bifascicular pacing: A novel multipoint left conduction system pacing method for cardiac resynchronization.

Marek Jastrzębski1, Aleksander Kusiak2, Darius Chapman3

  • 1First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland; Electrophysiology Laboratory, University Hospital in Krakow, Krakow, Poland.

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|October 15, 2025
PubMed
Summary

Bifascicular pacing improves cardiac synchrony more effectively than single-fascicle pacing in CRT candidates. This novel method enhances electrical and mechanical synchrony, potentially leading to better patient outcomes.

Keywords:
Bifascicular pacingCardiac resynchronization therapyConduction system pacingLeft inferior fascicleLeft superior fascicleR-wave peak time

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Resynchronization Therapy

Background:

  • Left bundle branch pacing can cause delays in contralateral fascicle segments.
  • Bifascicular (BiF) pacing may enhance cardiac resynchronization therapy (CRT) compared to single-fascicle pacing (LIF or LSF).

Purpose of the Study:

  • To compare synchrony between BiF and single-fascicle pacing.
  • To evaluate procedural, clinical, electrocardiographic, and echocardiographic outcomes of BiF pacing in CRT candidates.

Main Methods:

  • Assessed electrical and mechanical synchrony using paced QRS duration, QRS area, global R-wave peak time (RWPT), and dV/dt time.
  • Measured global longitudinal strain, peak strain dispersion (PSD), and global work efficiency.
  • Compared BiF, LIF, and LSF pacing parameters.

Main Results:

  • BiF pacing significantly reduced QRS duration, QRS area, global RWPT, and global dV/dt time compared to single-fascicle pacing.
  • BiF pacing increased global longitudinal strain and global work efficiency while decreasing PSD.
  • Lead I dV/dt time and RWPT correlated with mechanical dyssynchrony, particularly PSD.

Conclusions:

  • Bifascicular pacing is a physiological method that recruits the left conduction system more completely.
  • BiF pacing improves electrical and mechanical synchrony over single-fascicle pacing.
  • This improvement suggests potential for superior clinical outcomes in CRT patients.