Heart failure & cardiomyopathies
Optimal pace timing for left bundle branch area pacing with or without an additional LV lead: results from the CSPOT study
Authors' conclusion
LBBAP, LOT-CRT, and BVP are similarly sensitive to AV-timing. Optimal AV delay is linearly related to intrinsic AV for each resynchronization modality. For LOT-CRT and BVP, simultaneous biventricular activation is best on average.
Study context
- Population
- CRT-indicated patients
- Participants
- 48 patients
- Comparison
- Left bundle branch area pacing (LBBAP) vs LBBAP optimized cardiac resynchronization therapy (LOT-CRT) vs biventricular pacing (BVP): optimal atrioventricular (AV) and VV timing
- Outcome
- Optimal AV delay (vertex of parabolic fit to AV sweeps) by acute LV dP/dtmax and QRS duration; optimal VV timing
Methodological detailsacute haemodynamic study, paired comparison
- Acute haemodynamic study
- Paired comparison
Main finding
As reported in the abstract
Optimal paced AV delay (paced AV (PAV)) by LV dP/dtmax
LBBAP vs LOT-CRT: P < 0.01 · LBBAP vs BVP: P = 0.01
- LBBAP, LOT-CRT and BVP similarly sensitive to AV delay; 60 ms deviation from optimal AV reduced haemodynamic benefit by approximately
- 30%
Further findings
Optimal PAV by QRS duration — LBBAP vs LOT-CRT · similar
P = 0.52
| Outcome | P value |
|---|---|
| Optimal PAV by QRS durationLBBAP vs BVP · similar | P = 0.95 |
Patient-specific AV delay
- Linear regression of intrinsic AV conduction vs optimal AV delay gave patient-specific AV delay, improving AV selection vs fixed AV delay, for each modality
Optimal VV timing
- Simultaneous activation (VV = 0) best for both LOT-CRT and BVP
Original publication
Optimal pace timing for left bundle branch area pacing with or without an additional LV lead: results from the CSPOT study. Europace. Published 5 May 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →