ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Impact on mitral regurgitation in patients with AVB undergoing permanent pacemaker implantation: Left bundle branch pacing versus right ventricular septum pacing
Liang Shan
Peng Hao
Wenlong Dai
Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, China
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Abstract
Background: Patients with atrioventricular block (AVB) who require pacemaker implantation frequently present with varying degrees of mitral regurgitation (MR), which may influence left ventricular (LV) remodeling and function. This study aimed to evaluate the impact of left bundle branch pacing (LBBP) versus right ventricular septum pacing (RVSP) on MR severity and LV performance. Methods: A total of 137 consecutive AVB patients undergoing pacemaker implantation via LBBP or RVSP were retrospectively enrolled, after excluding those with previous mitral valve surgery or structural valvular abnormalities. Baseline and follow-up echocardiography were used to assess changes in MR severity and LV function, and subgroup analyses were performed among patients with baseline MR. Results: Out of the total, 88 patients (64.2%) successfully underwent LBBP. In the remaining 49 patients (35.8%) where LBBP could not be achieved, RVSP was performed. The average age and sex distribution were similar between the two groups. Significant changes in MR area and severity at follow-up were observed with LBBP compared to RVSP (P<0.05). LBBP was independently associated with a higher likelihood of MR improvement in patients who received pacemaker implants (HR=0.238, CI=0.105–0.538; P<0.001). At the follow-up, those in the LBBP subgroup with moderate or severe MR had significantly shorter lead-TVA-dist, increased left atrium diameters, worse LV ejection fraction (LVEF), and a higher mitral E/A ratio (P<0.05) compared to those in the none or mild MR subgroup. In cases of LBBP who showed a reduction in MR severity, there was a significant enhancement in LV remodeling (ΔLVEDD) from the baseline (P=0.009). Furthermore, these patients demonstrated a non-significant trend toward better LV function, reflected by greater changes in LVEF and E/A ratio (ΔLVEF and ΔE/A). Conclusion: LBBP significantly reduced MR severity and improved LV remodeling and systolic function compared with RVSP. Moreover, LBBP and baseline LVEDD were independently associated with a reduction in MR severity among AVB patients undergoing pacemaker implantation, highlighting the superiority of LBBP as a preferred pacing strategy in this population.
Summary
Keywords
Echocardiography, Mitral regurgitation, Left bundle branch pacing, left ventricular function, left ventricular remodeling, right ventricular septum pacing
Received
01 September 2025
Accepted
07 January 2026
Copyright
© 2026 Shan, Hao and Dai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Wenlong Dai
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