ORIGINAL RESEARCH article
Front. Physiol.
Sec. Cardiac Electrophysiology
This article is part of the Research TopicExercise Prescription, Physiological Mechanisms, and Exercise Safety in Patients with Cardiac Devices and ArrhythmiasView all articles
Is Conduction System Pacing Improving Cardiac Performances in Patients with Right Bundle Branch Block and Heart Failure?
Provisionally accepted
- Department of Radiation Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Objective: To evaluate the feasibility and safety of conduction system pacing (CSP) in patients with right bundle branch block (RBBB) and heart failure (HF). Methods: This retrospective study included all the patients with HF and ventricular pacing frequency more than 40% who underwent CSP between 2018 and 2023, with all enrolled patients presenting RBBB prior to the procedure. Clinical data including echocardiographic and electrocardiographic findings were collected before and after procedure, with a minimum follow-up duration of two year. Results: CSP was successfully performed in 78 patients (78/88, 88.63%), comprising 13 patients (13/78, 16.67%) with His-bundle pacing(HBP)and 65 patients（65/78, 83.33%）with left bundle branch pacing(LBBP). Significant improvements were observed in QRS duration (148.06 ± 17.91 ms vs. 121.87 ± 14.47 ms, P < 0.001), left ventricular ejection fraction (LVEF) (43.79 ± 11.71% vs. 46.94 ± 10.06%, P = 0.020), left ventricular end-diastolic diameter (LVEDD) (54.15 ± 7.67 mm vs. 52.71 ± 7.67 mm, P = 0.016), and NYHA functional class (2.97 ± 0.68 vs. 1.63 ± 1.08, P = 0.001). No significant change was noted in left atrial diameter (LAD)(44.72 ± 8.07mm vs. 43.86 ±8.42 mm, P = 0.114). Subgroup analysis revealed that the marked LVEF improvement were detected in patients with baseline LVEF ≤35% (30.05 ± 2.76% vs. 41.42 ± 11.61%, P = 0.001). Logistic regression analysis revealed that LVEF (OR = 0.112, 95% CI: 0.011-0.839, P = 0.001) and ΔQRS (OR = 1.449, 95% CI: 1.292-2.445, P = 0.021) were independent predictors of echocardiographic response. Conclusion: CSP is safe and effective for patients with RBBB and HF, with particularly notable improvements in cardiac performances among those with severely reduced LVEF.
Keywords: Conduction system pacing, His-bundle pacing, Left bundle branch pacing, Cardiacresynchronization therapy, right bundle branch block, Heart Failure
Received: 21 Aug 2025; Accepted: 04 Nov 2025.
Copyright: © 2025 Jia, Dong, Sun, Li, Wang, Ai, Xia and Yang. 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: Ying-xue Dong, dlsusan@126.com
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