{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T09:50:09Z","timestamp":1784195409224,"version":"3.55.0"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Left bundle branch pacing (LBBP) emerged as a novel physiological pacing modality that improves clinical outcomes. This study aimed to explore the impact of LBBP on QRS wave amplitude (RWA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This prospective observational study included patients with complete left bundle branch block (CLBBB) and cardiac resynchronization therapy (CRT) indication, as well as patients with QRSd\u2009&lt;\u2009120\u2009ms and pacemaker indication. During the procedure, when the LBBP lead reached the target site, 12\u2010lead ECGs at baseline and 1, 2, 3, 4, and 5 times the pacing thresholds and 3.5\u2009V (pacemaker default value) pacing were recorded, and RWA values were measured accordingly. The absolute values of I\u2009+\u2009aVL, II\u2009+\u2009III+\u2009aVF, and V1\u2009+\u2009V2\u2009+\u2009V3\u2009+\u2009V4\u2009+\u2009V5\u2009+\u2009V6 RWA were defined as X\u2010, Y\u2010, and Z\u2010axis \u03a3RWA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 195 consecutive patients (50 CLBBB and 145 narrow QRS) were enrolled (69.7\u2009\u00b1\u200910.3\u2009years, 52.3% male). Compared with the baseline, LBBP significantly increased X\u2010 and Y\u2010axis \u03a3RWA independent of pacing voltage in CLBBB (\u0394X\/Y\u2010axis 0.49\u2009\u00b1\u20090.78\u2009mV, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001\/0.61\u2009\u00b1\u20091.24\u2009mV, <jats:italic>p<\/jats:italic>\u2009=\u20090.001) and narrow QRS group (\u0394X\/Y\u2010axis 0.88\u2009\u00b1\u20090.61\u2009mV, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001\/0.91\u2009\u00b1\u20091.05\u2009mV, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001); LBBP significantly reduced Z\u2010axis \u03a3RWA in CLBBB patients (\u0394Z\u2010axis \u22122.64\u2009\u00b1\u20093.67\u2009mV, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) but not in narrow QRS group (\u0394Z\u2010axis \u22120.14\u2009\u00b1\u20091.87\u2009mV, <jats:italic>p<\/jats:italic>\u2009=\u20090.36). LBBP significantly improved cardiac function at 1\u2009week of follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>LBBP significantly increased X\/Y\u2010axis \u03a3RWA independent of pacing voltage in CLBBB and narrow QRS patients. LBBP significantly reduced Z\u2010axis \u03a3RWA in CLBBB but not in narrow QRS patients. Whether these \u03a3RWA changes, through enhancing whole myocardial contractility, have a synergistic effect with LBBP synchronization to further improve cardiac function remains to be investigated.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.16584","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T06:40:33Z","timestamp":1738219233000},"page":"762-770","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Left Bundle Branch Pacing Impact on QRS Amplitude in Different Pacing Voltages"],"prefix":"10.1111","volume":"36","author":[{"given":"Shengchan","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Geng","sequence":"additional","affiliation":[{"name":"Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0139-2352","authenticated-orcid":false,"given":"Zhixin","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiujuan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanying","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2033-4772","authenticated-orcid":false,"given":"Shigeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8783-8057","authenticated-orcid":false,"given":"Qijun","family":"Shan","sequence":"additional","affiliation":[{"name":"Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing 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