Interventricular septal LGE predicts response trajectories and clinical prognosis in heart failure patients undergoing left bundle branch area pacing

Zhu, K; Zhou, D; Zeng, J; Li, X; Zhu, H; Chen, J; Lai, Z; Zou, J; Lu, M; Fan, X

doi:10.1016/j.hrthm.2026.10.043

Interventricular septal LGE predicts response trajectories and clinical prognosis in heart failure patients undergoing left bundle branch area pacing

Heart RhythmPublished 22 Oct 2026two-center prospective observational study

Main finding · Adverse response progression (early to delayed or non-response), per 1% increase in IVS LGE%ResultAdjusted odds ratio 1.14 95% CI 1.05–1.23

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Authors' conclusion

IVS fibrosis independently predicts LBBAP response and prognosis in NICM patients with complete LBBB, and modulates LBBAP efficacy through a time-dependent biphasic mechanism.

Study context

Population: Patients with non-ischemic cardiomyopathy (NICM) and complete left bundle branch block (LBBB) who received left bundle branch area pacing (LBBAP), January 2021 to December 2024patients included
Participants: 113 patients

Exposure: Association between interventricular septal (IVS) LGE% and LBBAP response
Early respondersn = 86
Delayed respondersn = 13
Non-respondersn = 14
Outcome: Adverse response progression (early to delayed or non-response), per 1% increase in IVS LGE%

Methodological detailsconsecutively enrolled

Consecutively enrolled

Main finding

As reported in the abstract

Adjusted odds ratio

1.14

95% CI 1.05–1.23

P = 0.002

Each 1% increase in IVS LGE%

adjusted OR 1.14 (95% CI 1.05–1.23); P = 0.002

Each 1% increase in IVS LGE%, as printed

Observational data: associations, not effects.

Further findings

Response rate by IVS LGE% group · 12 months

Low IVS LGE%95.06%

Intermediate IVS LGE%93.75%

High IVS LGE%43.75%

Mediation of IVS fibrosis-related impairment by failed LBB capture · 6 and 12 months

6-month impairment mediated by failed LBB captured: 75.3%
6-month direct effect: P = 0.204
12-month mediation proportion: 60.8%
12-month direct inhibitory effect: β=−0.33, P=0.005

Optimal IVS LGE% cut-off values

Early response: 7.62%
Delayed response: 12.33%

Original publication

Interventricular septal LGE predicts response trajectories and clinical prognosis in heart failure patients undergoing left bundle branch area pacing. Heart Rhythm. Published 22 October 2026. doi:10.1016/j.hrthm.2026.10.043

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