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June 27, 2026EP EuropaceOpen Access

LV-only pacing linked to ~23% greater CRT response vs BiV pacing in HFrEF with LBBB.

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Why the study?

Does LV-only pacing improve left-ventricular reverse remodeling and clinical outcomes compared to biventricular pacing in patients with HFrEF and LBBB undergoing CRT?

Population

135 patients with HFrEF and left bundle branch block undergoing CRT implantation. Excluded: permanent AF…

Comparison

Left-ventricular-only pacing vs Conventional biventricular (BiV) pacing

Design

Cohort

Follow-up

12 months

Key result

Left-ventricular-only pacing was associated with a higher rate of CRT response compared to biventricular pacing (90% vs 73%, p=0.02) at 12 months in patients with HFrEF and LBBB.

Authors

ASA SpadottoGMG MartiniACA Carecci

Discussion

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Overview

LV-only pacing was associated with higher CRT response than BiV; hypothesis-generating and should not yet change practice.

Key Points

  • To compare the effectiveness of biventricular pacing vs. left-ventricular-only pacing in patients with left bundle branch block undergoing cardiac resynchronization therapy.
  • Single-center, prospective observational study enrolling 135 patients with HFrEF and LBBB from 2018 to 2023.
  • Patients classified as LV-only if ≥85% of pacing time was delivered to the left ventricle.
  • Echocardiographic evaluations performed at baseline and 12 months.
  • 90% of LV-only patients were CRT responders versus 73% in the BiV group (p = 0.02).
  • Annual all-cause mortality was 3.8%, with no significant difference between groups in major adverse cardiac events.
  • Both groups showed significant LV volume reductions, with more pronounced reverse remodeling in the LV-only group.

Study Design

Type

Observational (n=135)

Multicenter

No

Structured PICO

Does LV-only pacing improve left-ventricular reverse remodeling and clinical outcomes compared to biventricular pacing in patients with HFrEF and LBBB undergoing CRT?

P
Population
135 patients with HFrEF and LBBB undergoing CRT implantation, excluding those with permanent AF or NYHA IV symptoms, followed for 12 months.
E
Exposure
Left-ventricular-only (LV-only) pacing (fusion with intrinsic conduction via the right bundle, ≥85% of pacing time delivered to the left ventricle)
C
Comparator
Conventional biventricular (BiV) pacing
O
Outcome
Left-ventricular reverse remodeling at 12 months and clinical outcomes (all-cause mortality and major adverse cardiac events, defined as death, HF hospitalization, LVAD implantation, or heart transplantation)surrogate

Main Result

Absolute Event Rate: 90% vs 73%

p-value: p=0.02

In selected HFrEF patients with LBBB, LV-only pacing yields a higher rate of echocardiographic reverse remodeling compared to conventional biventricular pacing, with similar clinical outcomes.

Cite This Study

Spadotto et al. (2026) conducted an observational in HFrEF with left bundle branch block (LBBB) undergoing CRT (n=135). Left-ventricular-only pacing vs. Biventricular pacing was evaluated on CRT response (≥15% reduction in end-systolic volume) (p=0.02). Left-ventricular-only pacing was associated with a higher rate of CRT response compared to biventricular pacing (90% vs 73%, p=0.02) at 12 months in patients with HFrEF and LBBB.

synapsesocial.com/papers/6a3f97bb125782b61d86598ahttps://doi.org/10.1093/europace/euag105.809
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