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April 13, 2026Journal of Cardiovascular Electrophysiology

Nonspecific intraventricular conduction delay (OR 4.34, p=0.02), interventricular septal thickness (OR 1.39 per mm, p=0.03), and right atrial area (OR 1.12 per cm², p=0.01) were independent predictors of unsuccessful LBBAP, with the integrated model achieving an AUC of 0.84.

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Why the study?

What are the baseline clinical, electrocardiographic, and echocardiographic predictors of unsuccessful left bundle branch area pacing (LBBAP)?

Population

145 patients in whom left bundle branch area pacing (LBBAP) was attempted between April 2020 and March 2024

Design

Cohort

Authors

YOYousaku OkuboJMJunji MaedaSMShogo Miyamoto

Discussion

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Overview

A novel prediction model incorporating nonspecific intraventricular conduction delay, septal hypertrophy, and right atrial enlargement can effectively estimate the risk of unsuccessful left bundle branch area pacing to optimize patient selection.

Key Points

  • To identify predictors of unsuccessful left bundle branch area pacing (LBBAP) and develop a predictive model.
  • Analyzed data from 145 patients undergoing LBBAP between April 2020 and March 2024.
  • Defined procedural success with specific electrocardiographic criteria.
  • Compared clinical and echocardiographic variables between successful and unsuccessful implantation groups.
  • Utilized multivariable logistic regression to determine independent predictors of failure.
  • Constructed a nomogram for individualized risk estimation.
  • Success rate of LBBAP was 86.9%; failure rate was 13.1%.
  • Identified left bundle potentials, interventricular septal thickness, and right atrial area as key predictors of failure.
  • Model demonstrated an area under the curve (AUC) of 0.84, validated by bootstrap with AUC of 0.85.

Structured PICO

What are the baseline clinical, electrocardiographic, and echocardiographic predictors of unsuccessful left bundle branch area pacing (LBBAP)?

P
Population
145 patients in whom left bundle branch area pacing (LBBAP) was attempted between April 2020 and March 2024
I
Intervention
Left bundle branch area pacing (LBBAP)
O
Outcome
Procedural success of LBBAP (defined by ≥ 1 of: output‐dependent QRS morphology changes, V6 R‐wave peak time < 75 ms, V6–V1 interpeak interval ≥ 44 ms, or concordance between intrinsic and paced V6 RWPT derived from left bundle potentials)surrogate

A novel prediction model incorporating nonspecific intraventricular conduction delay, septal hypertrophy, and right atrial enlargement can effectively estimate the risk of unsuccessful left bundle branch area pacing to optimize patient selection.

Cite This Study

Okubo et al. (2026) studied this question.

synapsesocial.com/papers/69dc887f3afacbeac03ea53ahttps://doi.org/10.1111/jce.70339
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Also Consider

Synapse has enriched one closely related paper. Consider it for comparative context:

  1. 1Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging2015 · 8,513 citations