Evaluation of Acute Electrical and Hemodynamic Improvement During Left Bundle‐Branch Area Pacing Modalities for Resynchronization Therapy
4 affiliations
- 1Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine
- 2Fudan University
- 3Cardiac Rhythm Management, Medtronic Technology Center, Medtronic (Shanghai) Ltd.
- 4National Heart and Lung Institute, Imperial College London, Hammersmith Hospital
Abstract
Background While cardiac resynchronization therapy is effective in dyssynchronous heart failure, suboptimal response remains frequent. The acute hemodynamic profile of different left bundle‐branch (LBB) area pacing modalities is poorly defined. Moreover, atrioventricular optimization guided by QRS duration (QRSd) may not yield the greatest hemodynamic benefit. Methods Twenty‐four patients with heart failure, reduced ejection fraction, and LBB block underwent sequential testing of right ventricular septal pacing, left ventricular septal pacing, nonselective LBB pacing, and selective LBB pacing during cardiac resynchronization therapy implantation in a prospective, within‐subject physiological study. At each modality, electrical end points were QRSd and vectorcardiographic QRS area; hemodynamics were assessed with beat‐to‐beat systolic blood pressure (SBP). The atrioventricular interval producing maximal SBP improvement was compared with that producing the narrowest QRSd. Results LBB area pacing modalities significantly reduced QRSd , compared with right ventricular septal pacing (nonselective LBB pacing, 114.0±16.8 milliseconds; selective LBB pacing , 118.4±14.1 milliseconds; left ventricular septal pacing, 124.6±16.0 milliseconds; right ventricular septal pacing, 144.4±27.6 milliseconds; all P <0.01). At the atrioventricular interval that produced maximized SBP improvement, QRSd remained narrower with LBB area pacing than right ventricular septal pacing, and selective LBB pacing provided the greatest hemodynamic improvement ( ΔSBP 16.3±5.2 mm Hg ), exceeding left ventricular septal pacing (13.5±6.2 mm Hg ) and nonselective LBB pacing (12.8±6.3 mm Hg ; all P <0.05). Across modalities, the atrioventricular interval that maximized ΔSBP was consistently shorter than that minimizing QRSd (mean difference, 18–29 milliseconds). Conclusions Selective LBB pacing yields the greatest acute hemodynamic benefit, and the hemodynamic‐optimal atrioventricular interval is shorter than the electrical‐optimal atrioventricular interval, suggesting that modest atrioventricular interval shortening after electrical optimization may better maximize hemodynamics. Registration URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT07032064.
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BibTeX
@article{su2026evaluation,
title = {{Evaluation of Acute Electrical and Hemodynamic Improvement During Left Bundle‐Branch Area Pacing Modalities for Resynchronization Therapy}},
author = {Yanling Su and Ziqing Yu and Zilong Xiao and Lei Pan and Hongyang Lu and Juecheng Chen and Minghui Li and Xiao Li and Ahran D. Arnold and Zachary I. Whinnett and Yixiu Liang and Yangang Su},
journal = {Journal of the American Heart Association},
year = {2026},
month = oct,
doi = {10.1161/jaha.126.049208},
url = {https://www.ahajournals.org/doi/10.1161/JAHA.126.049208},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Evaluation of Acute Electrical and Hemodynamic Improvement During Left Bundle‐Branch Area Pacing Modalities for Resynchronization Therapy
AU - Yanling Su
AU - Ziqing Yu
AU - Zilong Xiao
AU - Lei Pan
AU - Hongyang Lu
AU - Juecheng Chen
AU - Minghui Li
AU - Xiao Li
AU - Ahran D. Arnold
AU - Zachary I. Whinnett
AU - Yixiu Liang
AU - Yangang Su
PY - 2026
DA - 2026/10/23
JO - Journal of the American Heart Association
DO - 10.1161/jaha.126.049208
UR - https://www.ahajournals.org/doi/10.1161/JAHA.126.049208
AB - Background While cardiac resynchronization therapy is effective in dyssynchronous heart failure, suboptimal response remains frequent. The acute hemodynamic profile of different left bundle‐branch (LBB) area pacing modalities is poorly defined. Moreover, atrioventricular optimization guided by QRS duration (QRSd) may not yield the greatest hemodynamic benefit. Methods Twenty‐four patients with heart failure, reduced ejection fraction, and LBB block underwent sequential testing of right ventricular septal pacing, left ventricular septal pacing, nonselective LBB pacing, and selective LBB pacing during cardiac resynchronization therapy implantation in a prospective, within‐subject physiological study. At each modality, electrical end points were QRSd and vectorcardiographic QRS area; hemodynamics were assessed with beat‐to‐beat systolic blood pressure (SBP). The atrioventricular interval producing maximal SBP improvement was compared with that producing the narrowest QRSd. Results LBB area pacing modalities significantly reduced QRSd , compared with right ventricular septal pacing (nonselective LBB pacing, 114.0±16.8 milliseconds; selective LBB pacing , 118.4±14.1 milliseconds; left ventricular septal pacing, 124.6±16.0 milliseconds; right ventricular septal pacing, 144.4±27.6 milliseconds; all P <0.01). At the atrioventricular interval that produced maximized SBP improvement, QRSd remained narrower with LBB area pacing than right ventricular septal pacing, and selective LBB pacing provided the greatest hemodynamic improvement ( ΔSBP 16.3±5.2 mm Hg ), exceeding left ventricular septal pacing (13.5±6.2 mm Hg ) and nonselective LBB pacing (12.8±6.3 mm Hg ; all P <0.05). Across modalities, the atrioventricular interval that maximized ΔSBP was consistently shorter than that minimizing QRSd (mean difference, 18–29 milliseconds). Conclusions Selective LBB pacing yields the greatest acute hemodynamic benefit, and the hemodynamic‐optimal atrioventricular interval is shorter than the electrical‐optimal atrioventricular interval, suggesting that modest atrioventricular interval shortening after electrical optimization may better maximize hemodynamics. Registration URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT07032064.
SN - 2047-9980
ER -