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June 27, 2026EP EuropaceOpen Access

LBBAP shortens QRS duration by 25 ms and reduces electrical dyssynchrony in complete AV block.

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Why the study?

To evaluate the feasibility of using ventricular dyssynchrony imaging and myocardial work indexes to characterize the benefits of left bundle branch area pacing.

Does left bundle branch area pacing improve electrical and mechanical synchrony compared to baseline in patients with complete atrioventricular block?

Population

5 patients with complete atrioventricular block

Comparison

LBBAP vs baseline

Design

Pilot study

Follow-up

Median 64 days

Key result

Left bundle branch area pacing significantly shortened QRS duration from 135 ms to 110 ms and reduced electrical dyssynchrony in patients with complete atrioventricular block.

Authors

RCR CalvaneseMCM CancielloGIG Izzo

Discussion

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Overview

LBBAP-associated synchrony gains merit prospective trials; leaves open whether VDI/MW indexes guide routine pacing decisions.

Key Points

  • To evaluate the feasibility of using ventricular dyssynchrony imaging and myocardial work indexes to assess the benefits of left bundle branch area pacing.
  • Five patients with complete atrioventricular block received permanent cardiac implantable electronic devices with a lead in the left bundle branch area.
  • Ventricular dyssynchrony imaging (VDI) was performed at baseline and follow-up to measure electrical dyssynchrony.
  • Echocardiographic pressure-strain loop analysis assessed left ventricular mechanical performance by deriving the global myocardial work index.
  • LBBAP significantly shortened QRS duration from 135 ± 16 ms to 110 ± 10 ms and reduced electrical dyssynchrony (VDI index median changed from 14 to −19).
  • At 64 days follow-up, three patients showed a significant increase in global myocardial work index from baseline, and echocardiographic ejection fraction improved by ≥5%.
  • No complications or threshold rise were observed during follow-up.

Structured PICO

Does left bundle branch area pacing improve electrical and mechanical synchrony compared to baseline in patients with complete atrioventricular block?

P
Population
5 patients (20% female, mean age 74 years) with complete atrioventricular block undergoing permanent implant of Cardiac Implantable Electronic Devices, followed for a median of 64 days.
I
Intervention
Permanent implant of Cardiac Implantable Electronic Devices (CIEDs) with a right ventricular pacing lead positioned in the left bundle branch area (LBBAP).
C
Comparator
Baseline (pre-implant intrinsic rhythm)
O
Outcome
Electrical dyssynchrony (QRS duration and interventricular activation delay via VDI) and left ventricular mechanical performance (global myocardial work index and efficiency via echocardiographic pressure-strain loop analysis)surrogate

Main Result

Absolute Event Rate: 110% vs 135%

In a small pilot study, left bundle branch area pacing improved electrical synchrony and left ventricular mechanical performance in patients with complete AV block.

Cite This Study

Calvanese et al. (2026) studied complete atrioventricular block (n=5). Left bundle branch area pacing (LBBAP) vs. baseline was evaluated on QRS duration. Left bundle branch area pacing significantly shortened QRS duration from 135 ms to 110 ms and reduced electrical dyssynchrony in patients with complete atrioventricular block.

synapsesocial.com/papers/6a3f97a5125782b61d865827https://doi.org/10.1093/europace/euag105.700
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