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June 27, 2026EP EuropaceOpen Access

LV septal LBBAP produces comparable acute increases in LV dp/dtmax versus right-sided pacing.

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Why the study?

Does left-sided LBBAP improve acute hemodynamics compared to right-sided LBBAP in patients requiring pacing?

Population

8 patients implanted with a permanent left bundle branch area pacing (LBBAP) device

Comparison

Left bundle branch area pacing delivered from… vs Right-sided LBBAP using the permanent LBBAP…

Design

Case_series

Follow-up

acute

Key result

Left bundle branch area pacing from the LV septum produced comparable acute increases in LV dp/dtmax compared to right-sided pacing (99.1 vs 72.1 mmHg/s; P=0.51).

Authors

ALA LiewNWN WijesuriyaSHS Howell

Discussion

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Overview

Acute hemodynamics similar for L- versus R-LBBAP; leaves open optimal site selection pending larger studies.

Key Points

  • To compare the acute hemodynamic effects of left and right bundle branch area pacing.
  • Eight patients received permanent LBBAP and underwent temporary pacing for hemodynamic testing.
  • Measurements included left ventricular dp/dtmax and right ventricular dp/dtmax during pacing.
  • Comparisons were made between R-LBBAP and L-LBBAP using invasive techniques.
  • No significant difference in ∆ LV dp/dtmax observed: 72.1 ± 128.6 mmHg/s for R-LBBAP vs. 99.1 ± 148.1 mmHg/s for L-LBBAP (P = 0.51).
  • No significant difference in ∆ RV dp/dtmax: -21.1 ± 22.7 mmHg/s for R-LBBAP vs. -22.8 ± 17.1 mmHg/s for L-LBBAP (P = 0.95).
  • Mean QRS duration reduced similarly for both: 25.4 ± 10.0ms for R-LBBAP vs. 31.6 ± 5.7ms for L-LBBAP (P = 0.60).

Structured PICO

Does left-sided LBBAP improve acute hemodynamics compared to right-sided LBBAP in patients requiring pacing?

P
Population
8 patients implanted with a permanent LBBAP undergoing acute invasive temporary pacing and hemodynamic testing.
I
Intervention
Left bundle branch area pacing delivered from the left ventricular septum (L-LBBAP) using a temporary catheter within the left ventricle
C
Comparator
Right-sided LBBAP (R-LBBAP) using the permanent LBBAP device in situ
O
Outcome
Maximum rate of left ventricular pressure rise (LV dp/dtmax) and right ventricular pressure rise (RV dp/dtmax)surrogate

Main Result

Absolute Event Rate: 99.1% vs 72.1%

p-value: p=0.51

Left-sided and right-sided left bundle branch area pacing produce comparable acute improvements in left ventricular contractility at the expense of right ventricular contractility.

Cite This Study

Liew et al. (2026) studied Patients implanted with permanent LBBAP (n=8). Left bundle branch area pacing delivered from the LV septum (L-LBBAP) vs. Right-sided LBBAP (R-LBBAP) was evaluated on Mean increase in ∆ LV dp/dtmax compared to baseline (p=0.51). Left bundle branch area pacing from the LV septum produced comparable acute increases in LV dp/dtmax compared to right-sided pacing (99.1 vs 72.1 mmHg/s; P=0.51).

synapsesocial.com/papers/6a3f97ce125782b61d865a46https://doi.org/10.1093/europace/euag105.813
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