AUTHOR=Fu Yuping , Liu Peng , Jin Lingyan , Li Yingqi , Zhang Yudi , Qin Xinghua , Zheng Qiangsun 

TITLE=Left bundle branch area pacing: A promising modality for cardiac resynchronization therapy

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.901046

DOI=10.3389/fcvm.2022.901046

ISSN=2297-055X

ABSTRACT=Cardiac resynchronization therapy (CRT) is recognized as the first-line management for patients with heart failure (HF) and conduction disorders. As a conventional mode for delivering CRT, biventricular pacing (BVP) improves cardiac function and reduces HF hospitalizations and mortality, but there are still limitations of high no response rates. Alternative pacing methods are needed either for a primary or rescue therapy. Recent years, conduction system pacing (CSP) has emerged as a more physiological pacing modality for simultaneous stimulation of the ventricles, including his bundle pacing (HBP) and left bundle branch pacing (LBBP). CSP directly activates the His-Purkinje system, providing normal stimulation order to ensure ventricular synchrony. However, HBP is technically challenging with relatively low success rate, high pacing threshold and failure to correct distal conduction abnormalities. Therefore, LBBP stands out as a novel ideal physiological pacing modality for CRT. Several nonrandomized studies compared feasibility and safety of LBBP with BVP and drew conclusions that LBBP is superior to BVP for delivering CRT with narrower QRS, greater improvement of left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) functional class. Concurrently, some studies showed lower and stable pacing thresholds and greater improvement of B-type natriuretic peptide (BNP) levels, as well as better mechanical synchronization and efficiency. LBBP ensures better ventricular electromechanical resynchronization compared with BVP. In this review, we discuss current knowledge of LBBP and comparison with BVP and explore the possibility of LBBP as an alternative primary therapy to realize cardiac resynchronization.