Biventricular endocardial pacing and left bundle branch area pacing for cardiac resynchronization: Mechanistic insights from electrocardiographic imaging, acute hemodynamic response, and magnetic resonance imaging

Ventricular dyssynchrony imaging, echocardiographic and clinical outcomes of left bundle branch pacing and biventricular pacing

“…With BVP activation of the ventricles utilizes non-physiological, slow cell-to-cell conduction from two opposite sites whereas LBBP employs the LV septal Purkinje conduction system, leading to a more synchronous activation pattern. These data are in line with recent reports of colleagues demonstrating superiority of LBBP over BVP regarding intra- and interventricular synchrony [ 11 , 12 ]. With LBBP, e-DYS would be anticipated to be slightly positive since activation of LV occurs before RV activation.…”

In silico experiments explain the non‐consistent benefit of conduction system pacing over cardiac resynchronization therapy. The need to personalize therapy

“…They applied five different CRT strategies including BIV‐CRT, LBBP, HBP, HBP with LV epicardial lead (HOT‐CRT), and LBBP with LV epicardial lead (LOT‐CRT). Consistent with prior observations from the same authors 7 and by Ponnusamy et al, 8 they hypothesized that virtual‐patients with septal scar or severe His‐Purkinje conduction disease—extending to the full His‐Purkinje network and not only the blocked region—would not benefit from CSP. Benefit of the different therapies was quantified by various metrics of ventricular dyssynchrony.…”

The Emerging Role of Left Bundle Branch Area Pacing for Cardiac Resynchronisation Therapy

“…LBBAP results in a greater shortening of the LV depolarisation time compared with BiVp (48.9 ± 12.5 ms versus 79.2 ± 13.1 ms; p<0.05), leading to a greater degree of intraventricular and interventricular synchrony (as indicated by a reduction in total ventricular activation time). [ 48 ] Moreover, patients undergoing LBBAP have been reported to exhibit a significant improvement in the acute haemodynamic response, determined by the maximum rate of LV pressure rise, compared with patients undergoing BiVp. [ 49 ]…”