Arrhythmias & electrophysiologyResearch article
The role of His-Purkinje system activation in preventing malignant reentrant ventricular arrhythmias during left bundle branch area pacing: Reverse electrical remodeling or restored left ventricular activation?
- computational models and clinical cases for hypothesis-generating support
- human biventricular model
- in silico
Authors' conclusion
Simulations suggest that LBBAP lowers arrhythmia vulnerability by restoring LV activation after LBBB and/or reversing electrical remodeling in patients with HF. Clinical validation through prospective studies is required.
Study context
- Population
- Human biventricular model with combinations of electrical remodeling from heart failure (HF), left bundle branch block (LBBB), and lateral left ventricular (LV) scar; patients with a history of ventricular arrhythmias receiving left bundle branch area pacing (LBBAP)
- Comparison
- LV activation during His pacing (HisP) with selective LBBAP, nonselective LBBAP, and biventricular pacing (BiVP)
Main finding
As reported in the abstract
HisP activation
- HisP activation differed with LBBB, but not with HF or LV scar
- in silico
Further findings
| Outcome | reduction in AVWs |
|---|---|
| Arrhythmia vulnerability windows (AVWs), HF models with LBBB · reduced with LBBAP | 50%-70% |
| Arrhythmia vulnerability windows (AVWs), all HF models · reduced with LBBAP | 14%-55% |
Activation in the LV myocardium and His-Purkinje system
- Selective LBBAP resembled HisP, whereas nonselective LBBAP and BiVP did not
Sustained reentry
- Sustained reentry was observed only in HF models
Ventricular arrhythmia burden in patients · >6-month follow-up
- In patients with and without conduction abnormalities or LV scar, LBBAP reduced ventricular arrhythmia burden
Original publication
The role of His-Purkinje system activation in preventing malignant reentrant ventricular arrhythmias during left bundle branch area pacing: Reverse electrical remodeling or restored left ventricular activation? Heart Rhythm. Published 24 March 2026. doi:10.1016/j.hrthm.2026.03.1887
Summarised from the published abstract; every number is checked against it