Differences in Tricuspid Valve Insufficiency, Mechanical Synchrony, and Cardiac Remodeling Between Left Bundle Branch Area Pacing and Right Ventricular Pacing

doi:10.1016/j.hrthm.2026.10.003

Arrhythmias & electrophysiologyCohort study

Differences in Tricuspid Valve Insufficiency, Mechanical Synchrony, and Cardiac Remodeling Between Left Bundle Branch Area Pacing and Right Ventricular Pacing

Heart RhythmPublished 9 Oct 2026

Cohort study

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Authors' conclusion

LBBAP was associated with less CIED-induced TR than RVP, likely through reduced mechanical interference, superior electrical synchrony, and favorable cardiac remodeling. Furthermore, LITR was associated with a worse prognosis than FTR.

Study context

Population: Patients with first-time RV apical pacing or RV septal pacing using stylet-driven leads, and left bundle branch area pacing (LBBAP) using lumenless leadsRV apical pacing (RVAP) 97 · RV septal pacing (RVSP) 78 · LBBAP 50
Participants: 225 patients

Exposure: left bundle branch area pacing versus right ventricular pacing
RVAPn = 97
RVSPn = 78
LBBAPn = 50

Main finding

As reported in the abstract

Baseline heart failure burden

Higher baseline heart failure burden with LBBAP than right ventricular pacing (RVP)

P< .001

Observational data: associations, not effects.

Further findings

TR progression rate · over 25.8 months

RVAP43.3%

RVSP35.9%

LBBAP20.0%

Outcome	RVAP	RVSP	LBBAP
Lead interference	50.5%	Not reported in the abstract	28.0%

TR progression rate — P value across groups: P=.020
Lead interference — Less lead interference with LBBAP than RVAP: P= .009

QRS duration

LBBAP shortened QRS duration (vs RVP widening): P < 0.001

Cardiac remodeling and mitral regurgitation

LBBAP showed greater left-heart reverse remodeling and improvement in mitral regurgitation, while preserving right-heart structure and function better than RVP

Adverse outcomes, LITR vs functional TR (FTR) · Over 37.4 months

LITR showed worse outcomes than FTR: P = 0.03

Independent predictors for adverse outcomes

LITR, pulmonary hypertension, reduced left ventricular ejection fraction, and elevated creatinine

Original publication

Differences in Tricuspid Valve Insufficiency, Mechanical Synchrony, and Cardiac Remodeling Between Left Bundle Branch Area Pacing and Right Ventricular Pacing. Heart Rhythm. Published 9 October 2026. doi:10.1016/j.hrthm.2026.10.003

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Summarised from the published abstract; every number is checked against it