Related Experiment Video

Updated: Jul 16, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

Lead-Related and Procedural Outcomes of His Bundle Pacing Versus Left Bundle Branch Area Pacing in Patients

Norma N Gamarra-Valverde1, Bezalel Hakkeem2, Joseph E Marine3

  • 1Universidad Peruana Cayetano Heredia Facultad de Medicina Alberto Hurtado Lima Peru.

Journal of Arrhythmia
|July 15, 2026
PubMed

Insights

Left bundle branch area pacing (LBBAP) shows better lead performance and procedural outcomes compared to His bundle pacing (HBP) in patients needing atrioventricular node ablation (AVNA). Further research is needed due to limited evidence.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Atrioventricular node ablation (AVNA) necessitates permanent pacing, highlighting the importance of lead performance and procedural durability.
  • His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) are advanced physiologic pacing strategies for AVNA patients.
  • Comparative evidence between HBP and LBBAP in this context is currently limited.

Purpose of the Study:

  • To systematically review and compare the lead-related and procedural outcomes of HBP versus LBBAP in adults undergoing AVNA.
  • To assess chronic lead-related dysfunction, procedural duration, and atrioventricular nodal reconduction rates between the two pacing strategies.

Main Methods:

  • A systematic literature search was conducted on PubMed/MEDLINE and Embase up to January 31, 2026.
  • Included were comparative studies of HBP versus LBBAP in adult AVNA patients.
  • Random-effects models were used to pool data for primary (lead dysfunction) and secondary (procedural duration, reconduction) outcomes, with certainty assessed by GRADE.

Main Results:

  • Three observational studies (434 patients) were included.
  • Left bundle branch area pacing (LBBAP) was associated with significantly lower rates of chronic lead-related dysfunction (RR 15.43) and atrioventricular nodal reconduction (RR 19.34) compared to His bundle pacing (HBP).
  • His bundle pacing (HBP) procedures were longer (MD 11.33 min), with very low certainty for lead dysfunction and reconduction outcomes.

Conclusions:

  • Left bundle branch area pacing (LBBAP) demonstrates more favorable lead-related and procedural outcomes than His bundle pacing (HBP) in patients undergoing AVNA, based on available observational data.
  • The current evidence is limited by small cohorts, sparse events, and nonrandomized designs.
  • Findings are considered hypothesis-generating and warrant further investigation through robust clinical trials.
Abstract

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