Arrhythmias & electrophysiology
Mid- to long-term mechanical performance of left bundle branch area pacing: a comprehensive echocardiographic comparison of capture modalities
Authors' conclusion
In patients with preserved LVEF, LBBAP maintains global mechanical performance comparable to intrinsic rhythm while increasing constructive and wasted work. Mechanical performance is largely similar between LBBP and LVSP, supporting the physiological value of LBBAP regardless of capture type.
Study context
- Population
- Patients with preserved LVEF and successful left bundle branch area pacing (LBBAP)
- Participants
- 88 patients
- Exposure
- LBBAP vs intrinsic rhythm; Left bundle branch pacing (LBBP) vs left ventricular septal pacing (LVSP)
- LBBPn = 63reference
- LVSPn = 25
- Outcome
- Mechanical performance (2D, speckle-tracking and myocardial work indices)
- Follow-up
- Median 18 months post-implant
Methodological detailssingle-centre, paired echocardiography (intrinsic vs paced rhythm)
- Single-centre
- Paired echocardiography (intrinsic vs paced rhythm)
Main finding
As reported in the abstract
Paced (LBBAP) vs intrinsic rhythm
| Outcome | LBBAP | Intrinsic rhythm | LBBP | LVSP | P value | |
|---|---|---|---|---|---|---|
| Global longitudinal strain | 16.2% | 16.8% | Not reported in the abstract | Not reported in the abstract | P = 0.040 | LBBP, LVSP: not reported in the abstract |
| Global constructive work | 2232.8 mmHg% | 2028.8 mmHg% | Not reported in the abstract | Not reported in the abstract | P < 0.001 | LBBP, LVSP: not reported in the abstract |
| Global wasted work | 266.2 mmHg% | 219.1 mmHg% | Not reported in the abstract | Not reported in the abstract | P = 0.003 | LBBP, LVSP: not reported in the abstract |
| Global work index | 1607.8 mmHg% | 1536.7 mmHg% | Not reported in the abstract | Not reported in the abstract | P = 0.171 | LBBP, LVSP: not reported in the abstract |
| GWE | 88.3% | 89.3% | Not reported in the abstract | Not reported in the abstract | P = 0.092 | LBBP, LVSP: not reported in the abstract |
Observational data: associations, not effects.
Further findings
LBBP vs LVSP, all parameters
- No statistically significant differences after covariate adjustment
- all P > 0.28
- LVSP independently predicted modest global work efficiency (GWE) decrease (multivariate)
Original publication
Mid- to long-term mechanical performance of left bundle branch area pacing: a comprehensive echocardiographic comparison of capture modalities. Europace. Published 29 October 2025. doi:10.
Summarised from the published abstract; every number is checked against it