Arrhythmias & electrophysiology
Hierarchical physiologic pacing to enhance clinical outcomes in conduction system pacing
Authors' conclusion
Hierarchical physiologic pacing with improved LVEF response is achieved with a closer position of the pacing lead to the His bundle and the LV endocardium.
Study context
- Population
- Patients with successful left bundle branch area pacing (LBBAP) undergoing computed tomographic angiography (CTA)with interpretable CTAs, of 264 patients analyzed
- Participants
- 172 patients
- Exposure
- Pacing lead location relative to the conduction tree hierarchy (LH) and the LV endocardium (LE) and left ventricular ejection fraction (LVEF) response
- Left bundle branch pacing (LBBP)n = 153
- Left ventricular septal pacing (LVSP)n = 19
- Outcome
- Lead position CTA parameters
Main finding
As reported in the abstract
LH median
27.7 mm
interquartile range, 9.21
LE median
0.80 mm
interquartile range, 2.59
Observational data: associations, not effects.
Further findings
LVEF improvement per 1 mm shorter LH
- LVEF increase per each 1 mm shorter LH
- 0.25%
- Adjusted for baseline LVEF
- P = 0.00637
LVEF response per additional 1 mm LE
- LVEF response increase per additional 1 mm LE
- 0.63%
- Entire cohort
- P = 0.0133
LVEF improvement in patients with depressed LVEF
- Significantly larger improvement in LVEF
- P < 0.0001 for both
Original publication
Hierarchical physiologic pacing to enhance clinical outcomes in conduction system pacing. Heart Rhythm. Published 26 April 2025. doi:10.
Summarised from the published abstract; every number is checked against it