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Updated: Mar 23, 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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In the Search of Noninvasive Methods Delineating Left Bundle Branch Block Amendable With Conduction System Pacing.

Tadej Žlahtič1,2, Vito Starc2, David Žižek1,2

  • 1University Medical Centre Ljubljana, Ljubljana, Slovenia.

Pacing and Clinical Electrophysiology : PACE
|March 21, 2026
PubMed
Summary
This summary is machine-generated.

Conduction system pacing (CSP) shows promise for cardiac resynchronization therapy (CRT). Analyzing equivalent dipole trajectories in patients with left bundle branch block (LBBB) can identify those best suited for CSP, improving CRT outcomes.

Keywords:
12‐lead electrocardiographybody surface potential mappingcardiac resynchronization therapyconduction system pacingleft bundle branch block

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Biomedical Engineering

Background:

  • Conduction system pacing (CSP) is an emerging cardiac resynchronization therapy (CRT) but is ineffective for approximately one-third of patients with left bundle branch block (LBBB) due to distal conduction disease.
  • Tailored patient selection for CRT is crucial, necessitating advanced analysis of ventricular depolarization patterns.

Purpose of the Study:

  • To evaluate the utility of equivalent dipole (ED) trajectories derived from high-resolution electrocardiograms (hrECGs) in differentiating proximal LBBB (pLBBB) from distal LBBB (dLBBB).
  • To assess the correlation between ED trajectory characteristics and CRT response in heart failure patients with LBBB undergoing CSP.

Main Methods:

  • Retrospective analysis of 12-lead hrECGs, ED trajectories, and echocardiograms in 18 heart failure patients with LBBB indicated for CRT and randomized to CSP.
  • Patients were categorized into pLBBB and dLBBB groups based on left bundle branch capture and left ventricular activation time.
  • Comparison of baseline characteristics, ED trajectory parameters (direction, velocity), QRS duration, and echocardiographic measures post-6 months of CRT.

Main Results:

  • The pLBBB group (n=12) exhibited distinct ED trajectories with an initial leftward direction (p=0.03) and slower, uniform velocity (p<0.001) compared to the dLBBB group (n=6).
  • Patients in the pLBBB group demonstrated significantly greater QRS duration shortening (26% vs. 14%, p<0.02) and improved left ventricular volumes (41.3% vs. 15.8%, p=0.004) and ejection fraction (17.1% vs. 5.5%, p=0.02) after 6 months.
  • ED trajectories differentiated pLBBB from dLBBB more effectively than standard 12-lead ECG criteria.

Conclusions:

  • Equivalent dipole trajectories from hrECGs offer a superior method for distinguishing proximal from distal LBBB compared to standard ECG analysis.
  • This advanced ECG analysis can aid in selecting appropriate candidates for conduction system pacing, optimizing cardiac resynchronization therapy outcomes.