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June 27, 2026EP EuropaceOpen Access

LV septal LBBAP produces comparable acute increases in LV dp/dtmax versus right-sided pacing.

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Why the study?

LBBAP is conventionally delivered from the right ventricular septum, and the hemodynamic effect of LBBAP delivered from the LV septum compared to right-sided LBBAP had not been studied.

Does left-sided LBBAP improve acute hemodynamics compared to right-sided LBBAP in patients requiring pacing?

Comparison

L-LBBAP via temporary catheter vs R-LBBAP using permanent device

Design

Invasive acute hemodynamic crossover testing

Key result

Left bundle branch area pacing from the LV septum produced comparable acute increases in LV dp/dtmax compared to right-sided pacing (99.1 vs 72.1 mmHg/s; P=0.51).

Authors

ALA LiewNWN WijesuriyaSHS Howell

Discussion

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Overview

Acute hemodynamics similar for L- versus R-LBBAP; leaves open optimal site selection pending larger studies.

Key Points

  • To compare the acute hemodynamic effects of left and right bundle branch area pacing.
  • Eight patients received permanent LBBAP and underwent temporary pacing for hemodynamic testing.
  • Measurements included left ventricular dp/dtmax and right ventricular dp/dtmax during pacing.
  • Comparisons were made between R-LBBAP and L-LBBAP using invasive techniques.
  • No significant difference in ∆ LV dp/dtmax observed: 72.1 ± 128.6 mmHg/s for R-LBBAP vs. 99.1 ± 148.1 mmHg/s for L-LBBAP (P = 0.51).
  • No significant difference in ∆ RV dp/dtmax: -21.1 ± 22.7 mmHg/s for R-LBBAP vs. -22.8 ± 17.1 mmHg/s for L-LBBAP (P = 0.95).
  • Mean QRS duration reduced similarly for both: 25.4 ± 10.0ms for R-LBBAP vs. 31.6 ± 5.7ms for L-LBBAP (P = 0.60).

Structured PICO

Does left-sided LBBAP improve acute hemodynamics compared to right-sided LBBAP in patients requiring pacing?

P
Population
8 patients implanted with a permanent LBBAP undergoing acute invasive temporary pacing and hemodynamic testing.
I
Intervention
Left bundle branch area pacing delivered from the left ventricular septum (L-LBBAP) using a temporary catheter within the left ventricle
C
Comparator
Right-sided LBBAP (R-LBBAP) using the permanent LBBAP device in situ
O
Outcome
Maximum rate of left ventricular pressure rise (LV dp/dtmax) and right ventricular pressure rise (RV dp/dtmax)surrogate

Main Result

Absolute Event Rate: 99.1% vs 72.1%

p-value: p=0.51

Left-sided and right-sided left bundle branch area pacing produce comparable acute improvements in left ventricular contractility at the expense of right ventricular contractility.

Cite This Study

Liew et al. (2026) studied Patients implanted with permanent LBBAP (n=8). Left bundle branch area pacing delivered from the LV septum (L-LBBAP) vs. Right-sided LBBAP (R-LBBAP) was evaluated on Mean increase in ∆ LV dp/dtmax compared to baseline (p=0.51). Left bundle branch area pacing from the LV septum produced comparable acute increases in LV dp/dtmax compared to right-sided pacing (99.1 vs 72.1 mmHg/s; P=0.51).

synapsesocial.com/papers/6a3f97ce125782b61d865a46https://doi.org/10.1093/europace/euag105.813
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Also Consider

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

  1. 1Comparisons of electrophysiological characteristics, pacing parameters and mid- to long-term effects in right ventricular septal pacing, right ventricular apical pacing and left bundle branch area pacing2022 · 10 citations
  2. 2Impact of left bundle branch area pacing on right cardiac chambers dimensions and function. a medium term single center echocardiographic study2024
  3. 3Assessing cardiac mechanical dyssynchrony in left bundle branch area pacing and right ventricular septal pacing using myocardial perfusion scintigraphy in the acute phase of pacemaker implantation2022 · 14 citations
  4. 4Comparing the acute biventricular hemodynamic effects of left bundle branch area pacing (LBBAP) and left bundle optimized cardiac resynchronization therapy (LOT-CRT)2026
  5. 5Medium- and Long-Term Lead Stability and Echocardiographic Outcomes of Left Bundle Branch Area Pacing Compared to Right Ventricular Pacing2021 · 16 citations