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April 13, 2026Journal of Cardiovascular Electrophysiology

Clinical Prediction Model for Unsuccessful Left Bundle Branch Area Pacing

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Why the study?

LBBAP has become a preferred form of cardiac physiologic pacing, but predictors of unsuccessful implantation remain unclear.

What are the baseline clinical, electrocardiographic, and echocardiographic predictors of unsuccessful left bundle branch area pacing (LBBAP)?

Population

145 patients undergoing attempted LBBAP

Comparison

Successful vs unsuccessful LBBAP implantation

Design

Observational prediction model study

Authors

YOYousaku OkuboHiroshima UniversityJMJunji MaedaHiroshima UniversitySMShogo MiyamotoHiroshima University

Discussion

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Implication

May optimize patient selection for LBBAP; hypothesis-generating and requires prospective validation before routine use.

Key Points

  • To identify predictors of unsuccessful left bundle branch area pacing (LBBAP) and develop a predictive model.
  • Analyzed data from 145 patients undergoing LBBAP between April 2020 and March 2024.
  • Defined procedural success with specific electrocardiographic criteria.
  • Compared clinical and echocardiographic variables between successful and unsuccessful implantation groups.
  • Utilized multivariable logistic regression to determine independent predictors of failure.
  • Constructed a nomogram for individualized risk estimation.
  • Success rate of LBBAP was 86.9%; failure rate was 13.1%.
  • Identified left bundle potentials, interventricular septal thickness, and right atrial area as key predictors of failure.
  • Model demonstrated an area under the curve (AUC) of 0.84, validated by bootstrap with AUC of 0.85.

Structured PICO

What are the baseline clinical, electrocardiographic, and echocardiographic predictors of unsuccessful left bundle branch area pacing (LBBAP)?

P
Population
145 patients in whom left bundle branch area pacing (LBBAP) was attempted between April 2020 and March 2024
I
Intervention
Left bundle branch area pacing (LBBAP)
O
Outcome
Procedural success of LBBAP (defined by ≥ 1 of: output‐dependent QRS morphology changes, V6 R‐wave peak time < 75 ms, V6–V1 interpeak interval ≥ 44 ms, or concordance between intrinsic and paced V6 RWPT derived from left bundle potentials)surrogate

A novel prediction model incorporating nonspecific intraventricular conduction delay, septal hypertrophy, and right atrial enlargement can effectively estimate the risk of unsuccessful left bundle branch area pacing to optimize patient selection.

Cite This Study

Okubo et al. (2026) studied this question.

synapsesocial.com/papers/69dc887f3afacbeac03ea53ahttps://doi.org/10.1111/jce.70339
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Mid-term clinical outcomes of left bundle branch area pacing compared to accurate right ventricular septal pacing2024 · 8 citations
  2. 2Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging2015 · 8,530 citations
  3. 3Left bundle branch area pacing outcomes: the multicentre European MELOS study2022 · 520 citations
  4. 4Predictors of implantation failure in left bundle branch area pacing using a lumenless lead in patients with bradycardia2023 · 22 citations
  5. 52023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure2023 · 541 citations