What question did this study set out to answer?

To evaluate whether electrocardiographic lead V8 can serve as an accurate, non-invasive marker of left ventricular posterolateral electrical delay during left bundle branch area pacing.

April 19, 2026Journal of Cardiovascular ElectrophysiologyOpen Access

The Resynchronization Effect in Left Bundle Branch Pacing Can be Evaluated Non‐Invasively With the Implementation of Lead V8

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Patients undergoing LOT-CRT implantation (n=30). Intervention: Lead V8 negative derivative activation time (NDAT-V8) vs. NDAT-V6 and R-wave peak time (RWPT) in V6 and V8. Primary outcome: Correlation with left ventricular electrical delay (LVED) during intrinsic conduction and LBBAP pacing subtypes (r = 0.922).

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Key result

NDAT-V8 outperforms NDAT-V6 and RWPT as a non-invasive surrogate for LV posterolateral wall delay during LBBAP.

r = 0.922
n=30

Why the study?

Does NDAT-V8 provide a reliable non-invasive surrogate for LV posterolateral wall delay during left bundle branch area pacing in patients undergoing LOT-CRT?

Comparison

NDAT-V8 vs NDAT-V6 and RWPT in V6 and V8

Authors

VRVadivelu RamalingamMcGill University Health Centre JKJohan van KollElectrophysiology PTPeter Tai

Discussion

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Implication

NDAT-V8 may enhance LBBAP resynchronization guidance; hypothesis-generating and requires prospective trials before routine adoption.

Key Points

To evaluate whether electrocardiographic lead V8 can serve as an accurate, non-invasive marker of left ventricular posterolateral electrical delay during left bundle branch area pacing.
Enrolled N=30 consecutive patients undergoing left-bundle-optimized cardiac resynchronization therapy (LOT-CRT).
Recorded 106 standard 12-lead ECGs with the V5 electrode moved to the V8 position, calculating the negative derivative activation time (NDAT) and comparing it to invasively measured left ventricular electrical delay (LVED).
NDAT-V8 strongly correlated with LVED during intrinsic conduction (r = 0.95) and across all combined left bundle branch pacing subtypes (r = 0.922; mean difference 2.5 ± 8 ms).
Correlations between NDAT-V8 and LVED remained high across specific pacing subtypes: LV septal (r = 0.92), non-selective LBBP (r = 0.91), RV septal (r = 0.89), and selective LBBP (r = 0.81).
NDAT-V8 demonstrated significantly stronger correlations with LVED than NDAT-V6 (r = 0.681), R-wave peak time (RWPT) in V6 (r = 0.626), and RWPT in V8 (r = 0.726).

Study Design

Type

Observational (n=30)

Structured PICO

Does NDAT-V8 provide a reliable non-invasive surrogate for LV posterolateral wall delay during left bundle branch area pacing in patients undergoing LOT-CRT?

Population

30 consecutive patients undergoing LOT-CRT implantation, contributing 106 ECG recordings to evaluate lead V8 as a marker of left ventricular delay.

Exposure

Measurement of negative derivative activation time (NDAT) using lead V8 (V5 repositioned to V8 location)

Comparator

LV electrical delay (LVED) determined from the LV lead, NDAT-V6, and R-wave peak time (RWPT) in V6 and V8

Outcome

Correlation between NDAT-V8 and LV electrical delay (LVED) during intrinsic conduction and LBB pacing subtypessurrogate

Main Result

Effect estimate: r = 0.922

NDAT-V8 is a reliable non-invasive surrogate for LV posterolateral wall delay during left bundle branch area pacing, outperforming standard V6 measurements.

Cite This Study

Ramalingam et al. (2026) conducted an observational in Patients undergoing LOT-CRT implantation (n=30). Lead V8 negative derivative activation time (NDAT-V8) vs. NDAT-V6 and R-wave peak time (RWPT) in V6 and V8 was evaluated on Correlation with left ventricular electrical delay (LVED) during intrinsic conduction and LBBAP pacing subtypes (r = 0.922). The negative derivative activation time in lead V8 (NDAT-V8) strongly correlated with left ventricular electrical delay during left bundle branch area pacing (combined r=0.922), outperforming V6.

synapsesocial.com/papers/69e473bd010ef96374d8f7b4 https://doi.org/10.1111/jce.70336

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The Resynchronization Effect in Left Bundle Branch Pacing Can be Evaluated Non‐Invasively With the Implementation of Lead V8

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

The Resynchronization Effect in Left Bundle Branch Pacing Can be Evaluated Non‐Invasively With the Implementation of Lead V8

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

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