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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

Insights

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.

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.
Abstract

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

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