Sex differences in left bundle branch pacing for cardiac resynchronization therapy: novel procedural insights into pacing lead location

doi:10.1016/j.hrthm.2026.09.045

Heart failure & cardiomyopathiesResearch article

Sex differences in left bundle branch pacing for cardiac resynchronization therapy: novel procedural insights into pacing lead location

Heart RhythmPublished 25 Sep 2026

retrospectively analyzed

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Authors' conclusion

Female patients had a better response to LBBP-CRT, potentially mediated by smaller baseline LVEDD, shorter paced QRS duration, and more frequent LBTP.

Study context

Population: Patients with heart failure and left bundle branch block who had cardiac resynchronization therapy (CRT) indications and achieved successful left bundle branch pacing (LBBP)patients with successful LBBP
Participants: 89 patients

Comparison: Sex differences in procedural performance and echocardiographic improvement

Main finding

As reported in the abstract

Screw-in attempts

female patients

2.0

± 1.0

male patients

3.2

± 2.0

Further findings

Left bundle branch trunk pacing (LBTP) rate

female patients33.3%

male patients9.4%

Super-response rate · 12-month follow-up

female patients75.0%

male patients43.4%

Paced QRS duration

female patients123.4 ± 14.4 ms

male patients134.3 ± 11.1 ms

LVEF improvement · 12-month follow-up

female patients22.3 ± 7.5% %

male patients16.5 ± 7.0% %

Outcome	OR	P value
Independent predictors of super-response (multivariable logistic regression) — paced QRS duration	0.94	P = 0.014
Independent predictors of super-response (multivariable logistic regression) — LVEDD	0.87	P = 0.011
Independent predictors of super-response (multivariable logistic regression) — LBTP vs LFP · pacing site	8.32	P = 0.028

Left bundle branch trunk pacing (LBTP) rate: P = 0.013
Paced QRS duration: P < 0.001
LVEF improvement: P < 0.001
Super-response rate: P = 0.003

LVEF improvement, LBTP vs left fascicular pacing (LFP)

LBTP was associated with greater LVEF improvement than LFP in both sexes: P < 0.05

Independent predictors of super-response (multivariable logistic regression)

mediation analyses suggested that these factors mediated the sex effect on super-response

Original publication

Sex differences in left bundle branch pacing for cardiac resynchronization therapy: novel procedural insights into pacing lead location. Heart Rhythm. Published 25 September 2026. doi:10.1016/j.hrthm.2026.09.045

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Summarised from the published abstract; every number is checked against it