ArticleFrontiers in physiology2025
Comparing the effects of left bundle branch pacing and leadless right ventricular pacing on intraventricular and interventricular dyssynchrony using
Article in Frontiers in physiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Non-physiological right ventricular pacing (RVP) is currently the mainstay of treatment for patients with high-degree atrioventricular (AV) block who have preserved left ventricular ejection fraction. Newer pacing strategies, such as left bundle branch pacing (LBBP) and leadless cardiac pacemakers (LCPMs), are increasingly being adopted due to their respective advantages over RVP. However, there has been no direct comparison between LCPMs and LBBP regarding their risk of pacing-induced cardiomyopathy, which is thought to arise from interventricular and intraventricular dyssynchrony. Using Methods: Using 19 four-chamber healthy heart geometries, we simulated LCPMs at the level of the right ventricular outflow tract-septum (RVOT-S), mid-septum (MS), and apical septum (AS), along with proximal left bundle pacing (PLBBP) and distal left bundle pacing (DLBBP) in 3 different settings: 1) intact left bundle branch conduction, 2) left bundle branch block (LBBB), and 3) septal scar involving the His-Purkinje system (HPS). Ventricular electrical uncoupling (VEU), absolute VEU, and left ventricular dyssynchrony index (LVDI) were measured. The shortest interval required to activate 90% of both ventricles (BIVAT-90) was also recorded. Results: In the setting of intact left bundle branch conduction, combined LBBP configurations had significantly lower VEU (LBBP: -3.3 ± 5.1 vs. LCPM: 24.2 ± 7.6 ms, Conclusion: LCPM produces less interventricular dyssynchrony than LBBP in the presence of extensive septal scarring involving the HPS. In the setting of proximal LBBB, LCPM at the RVOT-S level may be non-inferior to LBBP in terms of interventricular dyssynchrony.
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