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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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Related Experiment Video

Updated: Apr 14, 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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Left Bundle Branch Area Pacing Reverts Electromechanical Window Negativity to a Similar Extent as Biventricular

Florien Klein1,2, Metra Daliry1, Karin C Smits3

  • 1Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands.

Pacing and Clinical Electrophysiology : PACE
|April 13, 2026
PubMed
Summary

Left bundle branch area pacing (LBBAP) and biventricular pacing (BiVP) for cardiac resynchronization therapy (CRT) similarly improve the electromechanical window (EMW) in patients with baseline negative EMW. Both CRT methods effectively increase EMW, reducing instability.

Keywords:
biventricular pacingcardiac resynchronization therapyelectromechanical windowleft bundle branch area pacing

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Imaging

Background:

  • Left bundle branch area pacing (LBBAP) offers potential benefits over biventricular pacing (BiVP) in cardiac resynchronization therapy (CRT), including reduced arrhythmogenic risk.
  • Electromechanical window (EMW) is a critical indicator of cardiac electromechanical stability; a negative EMW is linked to increased risk of ventricular arrhythmias.

Purpose of the Study:

  • To investigate whether LBBAP-CRT can increase the electromechanical window (EMW) as effectively as BiVP-CRT.
  • To compare the impact of LBBAP-CRT versus BiVP-CRT on EMW and echocardiographic reverse remodeling.

Main Methods:

  • A cohort of 129 CRT recipients (63 LBBAP, 66 BiVP) was analyzed.
  • Electromechanical window (EMW) and echocardiographic parameters were assessed pre- and post-CRT implantation (6-12 months).
  • EMW was calculated using CW-Doppler echocardiography, subtracting the QT interval from the QAo interval.

Main Results:

  • EMW measurements were feasible in 86 patients (67%).
  • No significant difference in the change of EMW (ΔEMW) was found between LBBAP and BiVP groups.
  • Both LBBAP-CRT and BiVP-CRT significantly increased EMW in patients with a baseline negative EMW, with no significant difference between the pacing strategies.
  • Left ventricular ejection fraction improved and end-diastolic volume decreased similarly in both groups.
  • A negative EMW at baseline, not echocardiographic reverse remodeling, independently predicted EMW increase.

Conclusions:

  • In CRT patients presenting with a negative EMW, both LBBAP and BiVP achieve comparable improvements in EMW.
  • These findings suggest that LBBAP is a viable alternative to BiVP for CRT, particularly in patients with baseline electromechanical instability.