Left bundle branch vs biventricular pacing: mechanistic insights from a canine model
Hao Huang1, Yiran Hu1, Hui Li2
1Department of Cardiology, The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chines Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Beijing 100037, China.
European Heart Journal
|January 13, 2026
Summary
Left bundle branch pacing (LBBP) offers comparable QRS duration reduction and ejection fraction improvement to biventricular pacing (BiVP) in heart failure. LBBP demonstrates superior benefits in improving cardiac function and molecular markers.
Area of Science:
- Cardiology
- Biomedical Engineering
- Molecular Biology
Background:
- Dyssynchronous heart failure (DHF) presents a significant clinical challenge.
- Biventricular pacing (BiVP) is a standard therapy for DHF.
- Left bundle branch pacing (LBBP) is an emerging alternative pacing strategy.
Purpose of the Study:
- To compare the efficacy of LBBP versus BiVP in a DHF animal model.
- To evaluate electrocardiographic, echocardiographic, and molecular differences between LBBP and BiVP.
Main Methods:
- Adult canines underwent left bundle branch ablation to induce DHF.
- Groups received either BiVP or LBBP for 3 weeks.
- Measurements included ECG, echocardiography, and molecular analyses.
Main Results:
- Both LBBP and BiVP effectively reduced QRS duration and improved ejection fraction.
- LBBP showed significantly greater improvement in left ventricular global longitudinal strain.
- LBBP demonstrated superior modulation of cytoskeleton proteins, TGF-β signaling, and SERCA2a expression.
Conclusions:
- LBBP provides at least equivalent electrocardiographic and echocardiographic recovery compared to BiVP in DHF.
- LBBP offers superior benefits in normalizing cardiac cytoskeleton, calcium handling, and energy metabolism.
- LBBP represents a promising alternative pacing strategy for DHF.
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