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June 27, 2026EP EuropaceOpen Access

Initial LVAT under ~97ms predicts successful LBB capture.

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Why the study?

Contemporary criteria for successful LBBP focus on final paced parameters, but data on periprocedural implant predictors of left bundle branch capture remain limited.

Does initial LVAT predict successful left bundle branch capture in patients undergoing LBBP?

Population

192 patients who underwent LBBP

Comparison

Predictive value of periprocedural implant parameters for successful LBBP capture

Design

Observational cohort study

Key result

An initial left ventricular activation time (LVAT) ≤ 96.5ms predicted successful final left bundle branch capture with 75.7% sensitivity and 63.5% specificity (AUC 0.73).

Authors

FYF YangSNS NgXTX Y Teoh

Discussion

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Member takes

Overview

LBBP feasible in most cases; leaves open optimal selection criteria and long-term outcomes in prospective studies.

Key Points

  • The study aims to identify periprocedural implant parameters that predict successful left bundle branch capture in patients undergoing LBBP.
  • Analyzed 192 patients who underwent left bundle branch pacing.
  • Measured initial and final left ventricular activation time (LVAT) and QRS morphology.
  • Performed univariate and multivariate analyses using logistic regression and ROC curve analysis.
  • Successful left bundle branch pacing achieved in 72.9% of patients (23.4% selective, 76.6% non-selective).
  • Initial LVAT ≤ 96.5ms predicted successful final left bundle capture with 75.7% sensitivity and 63.5% specificity.
  • ROC analysis showed an area under the curve (AUC) of 0.73 for initial LVAT, outperforming the LVAT/QRS ratio.

Study Design

Type

Observational (n=192)

Structured PICO

Does initial LVAT predict successful left bundle branch capture in patients undergoing LBBP?

P
Population
192 patients (mean age 74.3, 43.8% female) undergoing left bundle branch pacing for indications including AV block and sick sinus syndrome.
E
Exposure
Measurement of initial left ventricular activation time (LVAT) prior to septal lead advancement during LBBP implantation
O
Outcome
Successful left bundle branch (LBB) capture (selective or non-selective, defined by LVAT ≤ 75ms in normal/RBBB or ≤ 85ms in LBBB, incomplete RBBB in V1, and V1–V6 inter-peak interval ≥ 33ms)surrogate

Main Result

Effect estimate: AUC 0.73

Limitations

  • Requires larger prospective studies to validate findings

Cite This Study

Yang et al. (2026) conducted an observational in Patients undergoing left bundle branch pacing (n=192). Initial left ventricular activation time (LVAT) was evaluated on Successful left bundle branch (LBB) capture (AUC 0.73). An initial left ventricular activation time (LVAT) ≤ 96.5ms predicted successful final left bundle branch capture with 75.7% sensitivity and 63.5% specificity (AUC 0.73).

synapsesocial.com/papers/6a3f9785125782b61d8657fahttps://doi.org/10.1093/europace/euag105.753
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