Electrophysiological predictors of super-response to left bundle branch area pacing in nonischemic cardiomyopathy: The PRECISION LBBAP study

Shroff, JP; Chandh Raja, D; Abhilash, SP; Mehta, A; Abhayaratna, WP; Vijayaraman, P; Sanders, P; Pathak, RK

doi:10.1016/j.hrthm.2026.03.1908

Electrophysiological predictors of super-response to left bundle branch area pacing in nonischemic cardiomyopathy: The PRECISION left bundle branch area pacing (LBBAP) study

Heart RhythmPublished 23 Mar 2026matched comparison of super-responders and partial responders to LBBAP using noninvasive electrocardiographic imaging

Main finding · Reduction in LVtatResultMean difference 15.2 ms 95% CI 3.4–27.1

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Authors' conclusion

Super-response to CRT via LBBAP was associated with greater reductions in ventricular dyssynchrony. The presence of definitive LBB capture emerged as a strong predictor of super-response, emphasizing the mechanistic relevance of conduction system engagement for optimizing CRT outcomes.

Study context

Population: Patients with nonischemic cardiomyopathy and left bundle branch (LBB) block (QRS >130 ms) who underwent LBBAP
Participants: 10 vs 10

Comparison: Super-responders compared with partial responders
Super-respondersn = 10
Partial respondersn = 10
Outcome: Reduction in LVtat

Main finding

As reported in the abstract

Mean difference

15.2 ms

95% CI 3.4–27.1

P = 0.015

Super-respondersvs partial responders

mean difference 15.2 ms (95% CI 3.4–27.1); P = 0.015

Further findings

Reduction in biventricular total activation time

P = 0.045

Super-responders29.0 msIQR 22.0–39.8

Partial responders16.5 msIQR 3.0–27.0

Outcome	Super-responders	Partial responders	P value
Ventricular electrical uncoupling improvement	55.7% (IQR 39.0–67.0)	5.8% (IQR −18.0–35.5)	P = 0.014
Reduction in LVtat, LBB capture vs LV septal capture			P < 0.001

Reduction in LVtat, LBB capture vs LV septal capture: Confirmed LBB capture 33.2 ± 10.4 ms
Reduction in LVtat, LBB capture vs LV septal capture: LV septal capture 13.1 ± 9.9 ms

LVtat reduction of ≥26.86% predicting LBB capture

Area under the curve: 0.96
Sensitivity: 83%
Specificity: 100%

Super-response with confirmed LBB capture

Higher odds of super-response: 7.4-fold

Bayesian regression

Original publication

Electrophysiological predictors of super-response to left bundle branch area pacing in nonischemic cardiomyopathy: The PRECISION LBBAP study. Heart Rhythm. Published 23 March 2026. doi:10.1016/j.hrthm.2026.03.1908

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