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Left bundle branch area pacing (LBBAP) may provide more physiological activation through direct conduction system engagement, yet comparative electrocardiographic (ECG) and procedural outcome data remain limited. Methods: A retrospective single-center study of 114 patients with left bundle branch block and LV ejection fraction ≤35% compared LBBAP-CRT versus BVP-CRT, assessing ECG metrics, pacing thresholds, complications, and procedural measures using logistic regression. Results: LBBAP-CRT produced greater QRS narrowing and lower pacing thresholds, with fewer complications. Conclusions: LBBAP-CRT showed superior electrical resynchronization and procedural safety, supporting further randomized trials.","Article  \nLeft Bundle Branch Area Pacing in Cardiac Resynchronization Therapy: How Does It Compare to Biventricular Pacing in Terms of Electrocardiographic Parameters and Procedural Outcomes?  \nTariel Atabekov *, Sergey Krivolapov , Roman Batalov  and Sergey Popov   \nAcademic Editors: Roberto  \nScacciavillani and Gemma Pelargonio Received: 3 December 2025  \nRevised: 20 December 2025  \nAccepted: 24 December 2025  \nPublished: 26 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \nCardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Kievskaya St., 111a, 634012 Tomsk, Russia; [psv@cardio-tomsk.ru](psv@cardio-tomsk.ru) (S.P.)  \n* Correspondence: [kgma1011@mail.ru](kgma1011@mail.ru)  \nAbstract  \nBackground/Objectives: Biventricular pacing (BVP) to deliver cardiac resynchronization therapy (CRT) is a standard intervention for heart failure, yet suboptimal response remains common due to challenges in left ventricular (LV) lead placement. Left bundle branch area pacing (LBBAP) has emerged as a promising alternative, offering physiological activation via direct conduction system engagement. However, comparative data on electrocardiographic (ECG) and procedural outcomes between LBBAP-CRT and BVP-CRT are limited. Methods: This retrospective, single-center study compared LBBAP-CRT and BVP-CRT in 114 patients with left bundle branch block and LV ejection fraction ≤ 35% . LBBAP-CRT was performed using a Medtronic SelectSecure™ 3830 lead via a fixed-curvesheath Medtronic C315HIS, with successful capture confirmed by ECG criteria (Qr/qRin V1, LV activation time \u003C 100 ms) . BVP-CRT involved coronary sinus LV lead placement. Outcomes included QRS duration, pacing thresholds, complications, and procedural metrics. Statistical analysis employed logistic regression to identify predictors of optimal pacing thresholds (≤1.0 V at 0.5 ms) . Results: LBBAP-CRT yielded greater degree of QRS narrowing than BVP-CRT (136.7 ± 13.5 ms vs. 147.2 ± 14.6 ms, p \u003C 0.001) and lower pacing thresholds (p \u003C 0.05) . Complications occurred in 18.1% of BVP-CRT patients (phrenic nerve stimulation, lead dislocation) versus none in LBBAP-CRT (p = 0.011) . According to the multivariable analysis LBBAP-CRT was associated with an optimal thresholds (p = 0.007), alongside lower E/e′ ratio and lead impedance. Conclusions: LBBAP-CRT was associated with superior electrical resynchronization, fewer complications, and better pacing thresholds compared to BVP, suggesting its potential as a preferred CRT strategy. Larger randomized trials are needed to validate long-term outcomes.  \nKeywords: cardiac resynchronization therapy; biventricular pacing; left bundle branch area pacing; electrocardiographic and procedural outcomes  \n1. Introduction  \nCardiac resynchronization therapy (CRT) is a standard treatment for patients with heart failure (HF) and electrical dyssynchrony, typically delivered via biventricular pacing (BVP) [1] . Despite its proven benefits, a significant proportion of patients exhibit suboptimal response, often due to challenges in achieving optimal left ventricular (LV) lead placement and effective resynchronization [2] . In recent years, left bundle branch area pacing (LBBAP) has emerged as a promising alternative to conventional BVP, offering a more physiological approach to ventricular activation by directly engaging the conduction system [3] .  \nLBBAP has demonstrated favorable outcomes in terms of lead stability, pacing thresholds, and correction of QRS duration in patients requiring CRT [4] . However, comparative data on electrocardiographic (ECG) parameters and procedural outcomes between LBBAPCRT and BVP-CRT remain limited. While BVP-CRT relies on simultaneous stimulation of the right ventricle (RV) and LV to restore synchrony, LBBAP-CRT aims to re","cbCaismivpfrwDyP","https://ap.wps.com/l/cbCaismivpfrwDyP","pdf",1794991,15,"English","en",105,"# Abstract\n## Background/Objectives\n## Methods\n## Results\n## Conclusions\n# Introduction\n# Materials and Methods\n## Study Design and Population\n## Consent","[{\"question\":\"What was the main purpose of comparing LBBAP-CRT and BVP-CRT?\",\"answer\":\"To evaluate differences in electrocardiographic parameters and procedural outcomes between left bundle branch area pacing–based CRT and biventricular pacing–based CRT, focusing on QRS characteristics and pacing/procedural metrics.\"},{\"question\":\"How many patients were included and what were the key eligibility requirements?\",\"answer\":\"The retrospective single-center study included 114 patients with left bundle branch block and LV ejection fraction ≤35%, with symptomatic heart failure and criteria supporting CRT-D implantation.\"},{\"question\":\"What outcomes favored LBBAP-CRT compared with BVP-CRT?\",\"answer\":\"LBBAP-CRT showed greater QRS narrowing and lower pacing thresholds, and it was associated with fewer complications (18.1% in BVP-CRT versus none in LBBAP-CRT).\"},{\"question\":\"What did the authors conclude and what further research was recommended?\",\"answer\":\"LBBAP-CRT was associated with superior electrical resynchronization, fewer complications, and better pacing thresholds, and larger randomized trials were recommended to validate long-term outcomes.\"}]","Left Bundle Branch Area Pacing in Cardiac Resynchronization Therapy - 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