Key result
LBBP plus RV lateral-wall pacing improves ventricular synchrony and RV function in severe RV dilatation.
Why the study?
LBBAP may lead to significant RV dyssynchrony that could affect clinical outcomes in certain patients.
Does combining left bundle branch pacing with right ventricular lateral wall pacing restore ventricular synchrony in a patient with severe right ventricular dilatation and AV conduction disease?
Case Report (n=1)
No
Does combining left bundle branch pacing with right ventricular lateral wall pacing restore ventricular synchrony in a patient with severe right ventricular dilatation and AV conduction disease?
Absolute Event Rate: 16% vs -36%
Combining left bundle branch pacing with right ventricular lateral wall pacing can successfully achieve right ventricular resynchronization in patients with severe RV dilatation.
May support combined pacing in select severe RV dilatation cases; leaves open confirmation in prospective trials.
Cardiac resynchronization therapy (CRT) is an effective treatment for patients with left bundle branch block (LBBB) and left ventricular (LV) dyssynchrony. Left bundle branch area pacing (LBBAP) has recently emerged as a promising physiological alternative to conventional right ventricular pacing (RVP) and CRT [1,2], but may lead to significant right ventricular (RV) dyssynchrony, which might affect clinical outcomes in a specific group of patients [3]. Here, we present a case of successful right ventricular cardiac resynchronization therapy (RV-CRT) achieved by combining LBB pacing (LBBP) with RV lateral wall pacing to restore ventricular synchrony in a patient with intermittent atrioventricular (AV) conduction disease and severe RV dilatation due to an unrepaired atrial septal defect.
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Zhao et al. (2026) conducted a case report in An 86-year-old woman with severe right ventricular dilatation due to an unrepaired secundum atrial septal defect, intermittent third-degree atrioventricular conduction disease, spontaneous right bundle branch block, preserved left ventricular ejection fraction of 55%, and NYHA functional class III symptoms. (n=1). Left bundle branch pacing (LBBP) combined with right ventricular (RV) lateral wall pacing (RV-CRT) vs. spontaneous rhythm and non-selective LBBP alone was evaluated on Interventricular mechanical delay (IVMD) and right ventricular (RV) synchrony improvement measured by UHF-ECG and echocardiography; clinical symptom improvement. Left bundle branch pacing combined with right ventricular lateral-wall pacing improved interventricular synchrony (IVMD improved from -36 ms to +16 ms) and RV function in a patient with severe RV dilatation.
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