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Updated: Feb 18, 2026

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Left bundle cardiac resynchronization therapy versus left bundle optimized cardiac resynchronization therapy.

Chinmay Parale1, Suresh Kumar Sukumaran1, Dinakar Bootla1

  • 1Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Indian Pacing and Electrophysiology Journal
|February 16, 2026
PubMed
Summary
This summary is machine-generated.

Adding a coronary sinus lead to left bundle branch area pacing for cardiac resynchronization therapy (LB-CRT) did not show additional benefits compared to standard LB-CRT. Left bundle optimized CRT (LOT-CRT) showed similar outcomes in patients with non-ischemic cardiomyopathy and LBBB.

Keywords:
Cardiac resynchronization therapyConduction system pacingEchocardiographyLeft bundle branch area pacingNon-ischemic cardiomyopathy

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Pacing

Background:

  • Left bundle branch area pacing (LB-CRT) is a CRT technique.
  • Left bundle optimized CRT (LOT-CRT) involves adding a coronary sinus lead to LB-CRT.
  • The potential added benefit of LOT-CRT over LB-CRT requires investigation.

Purpose of the Study:

  • To compare echocardiographic and clinical outcomes between LB-CRT and LOT-CRT.
  • To evaluate the efficacy of LOT-CRT in patients with specific cardiac conditions.

Main Methods:

  • A single-center randomized controlled trial was conducted.
  • Patients with non-ischemic cardiomyopathy and LBBB (LVEF < 35%) were included.
  • Participants were randomized to LB-CRT or LOT-CRT, with follow-up at 6 months.

Main Results:

  • No significant difference in LVEF change between LB-CRT (15.7 ± 12.8%) and LOT-CRT (11.4 ± 14.2%).
  • Response rates were comparable: 72.7% for LB-CRT and 71.4% for LOT-CRT.
  • LVESV and 6-minute walk distance showed no significant differences between groups.

Conclusions:

  • LOT-CRT does not provide additional benefit over LB-CRT in patients with non-ischemic cardiomyopathy and LBBB.
  • Standard LB-CRT is as effective as LOT-CRT in this patient population.