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Left bundle branch area pacing or conventional cardiac resynchronization therapy: an Electrophysiology-guided

Asit Das1,2, Gaurav Lakhani3

  • 1Department of Cardiology, Institute of Post graduate Medical Education and Research, Kolkata, West Bengal, India. dradascard@rediffmail.com.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
|November 14, 2025
PubMed

Insights

Electrophysiology-guided resynchronization therapy improves outcomes in patients with dilated cardiomyopathy and left bundle branch block. This tailored approach offers superior electrical and mechanical benefits compared to standard CRT.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Conventional biventricular pacing (BiV-CRT) is standard for dilated cardiomyopathy (DCM) with left bundle branch block (LBBB).
  • Up to 30% of patients do not respond to BiV-CRT.
  • Left bundle branch area pacing (LBBAP) is an emerging alternative therapy.

Purpose of the Study:

  • To compare the efficacy of electrophysiology (EP)-guided resynchronization therapy versus conventional CRT-D.
  • To evaluate electrical and mechanical outcomes in patients with DCM, severe LV dysfunction, and LBBB.

Main Methods:

  • 84 patients with DCM, severe LV dysfunction, and LBBB were enrolled.
  • Patients were randomized to conventional CRT-D or EP-guided resynchronization.
  • EP-guided therapy involved left septal and His bundle mapping to guide pacing site selection.

Main Results:

  • EP-guided therapy significantly reduced QRS duration (116.18±8.12 ms vs. 128.26±6.81 ms).
  • Left ventricular ejection fraction (LVEF) improved more with EP-guided therapy (39.21±2.07% vs. 34.20±3.65%).
  • Higher responder rates were observed with EP-guided therapy (97.4% vs. 80%).

Conclusions:

  • EP-guided tailored resynchronization offers superior electrical and mechanical benefits.
  • This approach achieves a higher patient response rate compared to conventional CRT.
  • EP-guided therapy represents an effective alternative for non-responders to standard CRT.
Abstract

Keywords:
Cardiac resynchronization therapyDilated cardiomyopathyElectrophysiology-guided therapyLeft bundle branch area pacing

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