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August 31, 2026CJC OpenOpen Access

Bi-bundle branch pacing narrows QRS and improves LVEF by ~32% in a severe heart failure case.

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Why the study?

Does bi-bundle branch pacing improve biventricular synchrony and clinical outcomes in a patient with severe heart failure and wide LBBB?

Population

One 72-year-old man with severe heart failure (LVEF 21%) and wide LBBB (QRS 227 ms)

Comparison

Bi-bundle branch pacing using RV defibrillation lead and separate LBBP lead in CRT-D

Design

Case report

Follow-up

2-month

Key result

Bi-bundle branch pacing in a CRT-D system narrowed QRS from 227 to 137 ms and improved LVEF from 21% to 53% at 2 months in a patient with severe heart failure.

Authors

JSJiabo ShenLJLongfu JiangHLHengdong Li

Discussion

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Member takes

Overview

May improve synchrony and LVEF in select LBBB-HF cases; leaves open prospective validation of bi-bundle pacing.

Key Points

  • To describe the implementation and clinical impact of simultaneous bi-bundle branch pacing in a cardiac resynchronization therapy defibrillator system for severe heart failure.
  • Implemented a bi-bundle branch pacing CRT-D system in a 72-year-old male with severe heart failure, a baseline left ventricular ejection fraction of 21%, and left bundle branch block with a QRS duration of 227 ms.
  • Delivered selective right bundle branch pacing via the right ventricular defibrillation lead combined with selective left bundle branch pacing through a separate lead.
  • Simultaneous bi-bundle pacing improved biventricular synchrony, narrowing the QRS duration from 227 ms to 137 ms.
  • At 2-month follow-up, left ventricular ejection fraction increased from 21% to 53%, with functional improvement to NYHA functional class I.

Study Design

Type

Case Report (n=1)

Structured PICO

Does bi-bundle branch pacing improve biventricular synchrony and clinical outcomes in a patient with severe heart failure and wide LBBB?

P
Population
A 72-year-old man with severe heart failure and wide LBBB treated with bi-bundle branch pacing and followed for 2 months.
I
Intervention
Bi-bundle branch pacing strategy in a CRT-D system (selective right bundle branch pacing using the RV defibrillation lead combined with selective left bundle branch pacing via a separate lead)
O
Outcome
Biventricular synchrony (QRS duration), clinical improvement (NYHA class), and echocardiographic improvement (LVEF) at 2-month follow-upsurrogate

Bi-bundle branch pacing using an RV defibrillation lead and a separate LBBP lead is a feasible strategy to improve resynchronization in CRT-D patients.

Limitations

  • Remains exploratory pending further evidence
  • exploratory pending further evidence

Cite This Study

Shen et al. (2026) conducted a case report in Severe heart failure and wide LBBB (n=1). Bi-bundle branch pacing strategy in a CRT-D system was evaluated on QRS duration, NYHA class, and LVEF. Bi-bundle branch pacing in a CRT-D system narrowed QRS from 227 to 137 ms and improved LVEF from 21% to 53% at 2 months in a patient with severe heart failure.

synapsesocial.com/papers/6a953aec6af7ed2fcaea0c64https://doi.org/10.1016/j.cjco.2026.08.014
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Also Consider

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

  1. 1Multicenter Hemodynamic Assessment of the LOT-CRT Strategy: When Does Combining Left Bundle Branch Pacing and Coronary Venous Pacing Enhance Resynchronization?: Primary Results of the CSPOT Study2024 · 51 citations
  2. 2Left bundle branch area pacing in patients with heart failure and right bundle branch block: Results from International LBBAP Collaborative-Study Group2022 · 64 citations
  3. 3Left bundle branch area pacing outcomes: the multicentre European MELOS study2022 · 517 citations
  4. 4Conduction system pacing, a European survey: insights from clinical practice2023 · 87 citations
  5. 5Electrocardiographic Analysis for His Bundle Pacing at Implantation and Follow-Up2020 · 78 citations