Arrhythmias & electrophysiology
Characteristics and Mechanisms of Septal Myocardial Injury and Repair Following Left Bundle Branch Area Pacing
Authors' conclusion
LBBAP with >3 deep septal screwing attempts was associated with a higher risk of septal myocardial injury and markedly thickened concentric reparative layers, underpinned by more pronounced sterile inflammation, profibrotic remodeling, and foreign body reaction.
Study context
- Population
- Patients with bradycardia undergoing left bundle branch area pacing (LBBAP); LBBAP caninespatients with bradycardia, 24 LBBAP canines in the animal study · patients 41 · LBBAP canines 24
- Participants
- 41 patients
- Exposure
- Patients with >3 attempts compared to patients with ≤ 3 attempts
- Outcome
- Creatine kinase-MB (CK-MB) elevation
Methodological detailscanine study
- Canine study
Main finding
As reported in the abstract
≤ 3 attempts
6
%
>3 attempts
44%
Observational data: associations, not effects.
Further findings
%
| Outcome | ≤ 3 attempts | >3 attempts |
|---|---|---|
| LV endocardial GLS | −17.9 | −13.6 |
| Mid-myocardial GLS | −15.3 | −12.4 |
- Left ventricular (LV) endocardial global longitudinal strain (GLS): less negative with >3 attempts
- LV endocardial GLS: P<0.001
- Mid-myocardial GLS: less negative with >3 attempts
- Mid-myocardial GLS: P<0.001
Molecular changes in canines
- Molecular changes associated with >3 attempts featured amplified HMGB1-centered sterile inflammation and enhanced CD206+ macrophage-mediated profibrotic remodeling
- Animal study
Reparative layers in canines
- Canines with >3 attempts were characterized by three markedly thickened concentric reparative layers around the lead-inner thrombus layer, middle fibrous sheath layer, and outer reactive fibrotic layer
Lead removal after >3 attempts
- Removal of the pacing lead after >3 attempts resulted in only mild scattered fibrosis, with markedly attenuated CD206+ macrophage-mediated profibrotic pathway
Original publication
Characteristics and Mechanisms of Septal Myocardial Injury and Repair Following Left Bundle Branch Area Pacing. Heart Rhythm. Published 4 November 2026. doi:10.
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