Why the study?
Left bundle branch pacing is an alternative to conventional biventricular pacing for cardiac resynchronization therapy.
Does left bundle branch pacing improve inter- and intraventricular synchrony compared to baseline LBBB and other pacing modalities in a patient referred for CRT?
Does left bundle branch pacing improve inter- and intraventricular synchrony compared to baseline LBBB and other pacing modalities in a patient referred for CRT?
LBBP provides superior inter- and intraventricular resynchronization compared to RVSP and LVSP in a patient with LBBB, as demonstrated by real-time ECGi and low-frequency QRS analysis.
LBBP may enhance synchrony metrics in LBBB; this case report leaves open superiority over other modalities before changing CRT practice.
Introduction: Left bundle branch pacing (LBBP) is an alternative to conventional biventricular pacing for cardiac resynchronization therapy (CRT). Methods: A 76-year-old male was referred for CRT via left bundle branch pacing (LBBP). We present the real-time characterization of the transition from intrinsic left bundle branch block (LBBB) to sequential pacing modalities: right ventricular septal pacing (RVSP), left ventricular septal pacing (LVSP), and finally LBBP. Epicardial activation maps from electrocardiographic imaging (ECGi) and low-frequency (LF) QRS analysis were used to provide complementary insights into interand intraventricular synchrony. Results: LVSP, LBBP, and anodal capture improved activation compared with baseline, with LBBP achieving the greatest improvements in interventricular and LV intraventricular synchrony despite higher RV dispersion. Conclusion: These findings highlight ECGi and LF QRS as valuable tools to guide CRT.
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Sales‐Bellés et al. (2026) studied this question.
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