Clinical Prediction Model for Unsuccessful Left Bundle Branch Area Pacing
Yousaku Okubo1, Junji Maeda1, Shogo Miyamoto1
1Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
Journal of Cardiovascular Electrophysiology
|April 11, 2026
Summary
Left bundle branch area pacing (LBBAP) is a common cardiac pacing method. Nonspecific intraventricular conduction delay, septal hypertrophy, and right atrial enlargement independently predict LBBAP failure, aiding patient selection.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- Left bundle branch area pacing (LBBAP) is increasingly utilized for cardiac physiologic pacing.
- Predictors for unsuccessful LBBAP implantation require further clarification.
Purpose of the Study:
- To identify independent predictors of unsuccessful LBBAP implantation.
- To develop a predictive model for LBBAP procedural success.
Main Methods:
- Analysis of 145 patients undergoing LBBAP between April 2020 and March 2024.
- Multivariable logistic regression (Firth's penalized likelihood) to identify predictors of procedural failure.
- Procedural success defined by specific electrocardiographic criteria.
Main Results:
- Nonspecific intraventricular conduction delay (NIVCD) (OR=4.34), interventricular septal thickness (IVSd) (OR=1.39 per mm), and right atrial area (RAA) (OR=1.12 per cm²) were independent predictors of LBBAP failure.
- The predictive model demonstrated strong discrimination (AUC=0.84, validated AUC=0.85).
Conclusions:
- NIVCD, septal hypertrophy, and right atrial enlargement are key predictors of LBBAP failure.
- A validated prediction model and nomogram offer individualized pre-procedural risk assessment for LBBAP.
- These tools may optimize patient selection and procedural strategies for LBBAP.
