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Bradyarrhythmias are cardiac rhythm disorders characterized by a slower-than-normal heart rate, typically defined as fewer than 60 beats per minute. Some of which are discussed here:Sinus BradycardiaSinus bradycardia presents a heart rate lower than 60 beats per minute, with a regular rhythm originating from the SA node. The ECG typically shows normal P waves preceding each QRS complex, a normal PR interval (0.12 to 0.20 seconds), and a normal QRS duration (0.06 to 0.10 seconds).First-Degree AV...
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Left heart catheterization is an invasive diagnostic procedure used to evaluate the function and structure of the left side of the heart. It is generally performed to diagnose and treat cardiovascular conditions such as valve abnormalities, coronary artery disease, and congenital heart defects.Diagnostic and therapeutic purposesLeft heart catheterization serves various diagnostic and therapeutic purposes, including:Assessing coronary artery bypass grafts.Evaluating coronary artery disease in...
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Updated: Feb 28, 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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Sex-Based Differences in Left Bundle Branch Capture During Left Bundle Branch Area Pacing.

Ilya Y Shadrin1,2, Sara A Coles1, Claus Graff3

  • 1Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, North Carolina, USA.

Pacing and Clinical Electrophysiology : PACE
|February 25, 2026
PubMed
Summary
This summary is machine-generated.

Sex-based differences in left bundle branch (LBB) capture criteria were identified in patients undergoing LBB area pacing (LBBAP). Shorter R-wave peak times (RWPTs) in females normalized when accounting for heart size, suggesting sex-specific criteria may be needed.

Keywords:
R‐wave peak timeconduction system pacingfemaleleft bundle branch area pacingleft bundle branch capturemalepermanent pacemakersex‐based differences

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Area of Science:

  • Electrophysiology
  • Cardiac Pacing
  • Electrocardiography

Background:

  • Left bundle branch area pacing (LBBAP) is an alternative to traditional pacing.
  • Established criteria for LBB capture lack sex-specific considerations despite known sex differences in QRS duration.

Purpose of the Study:

  • To investigate sex-based differences in meeting left bundle branch (LBB) capture criteria on postimplant electrocardiograms (ECGs).
  • To determine if current LBB capture criteria require sex-specific adjustments in LBB area pacing.

Main Methods:

  • Retrospective analysis of 222 patients (>18 years) who underwent dual-chamber LBBAP pacemaker implantation (2020-2023).
  • Assessment of baseline and postoperative day 1 (POD1) ECGs for electrical dyssynchrony.
  • Left bundle branch capture defined by R-wave peak times (RWPTs) per EHRA 2023 Consensus algorithm.

Main Results:

  • Females had shorter baseline QRS duration than males (122 ms vs. 126 ms, p=0.018).
  • LBB capture criteria were met by 58.0% of males and 70.9% of females (p=0.058).
  • Females exhibited shorter V6-RWPTs (~7 ms shorter, p=0.0008); differences resolved when normalizing for smaller heart size.

Conclusions:

  • Females with LBB capture show shorter V6-RWPTs, but this difference is size-dependent.
  • Current LBB capture criteria may not be universally applicable across sexes.
  • Further research is needed to establish sex-specific criteria for LBB capture assessment.