{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T03:04:59Z","timestamp":1789614299490,"version":"build-2803163510"},"reference-count":25,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,2,17]],"date-time":"2021-02-17T00:00:00Z","timestamp":1613520000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture). Objective: To investigate acute electrophysiological effects of LBBP and LVSP as compared to intrinsic ventricular conduction. Methods: Fifty patients with normal cardiac function and pacemaker indication for bradycardia underwent LBBAP. Electrocardiography (ECG) characteristics were evaluated during pacing at various depths within the septum: starting at the right ventricular (RV) side of the septum: the last position with QS morphology, the first position with r\u2019 morphology, LVSP and\u2014in patients where left bundle branch (LBB) capture was achieved\u2014LBBP. From the ECG\u2019s QRS duration and QRS morphology in lead V1, the stimulus- left ventricular activation time left ventricular activation time (LVAT) interval were measured. After conversion of the ECG into vectorcardiogram (VCG) (Kors conversion matrix), QRS area and QRS vector in transverse plane (Azimuth) were determined. Results: QRS area significantly decreased from 82 \u00b1 29 \u00b5Vs during RV septal pacing (RVSP) to 46 \u00b1 12 \u00b5Vs during LVSP. In the subgroup where LBB capture was achieved (n = 31), QRS area significantly decreased from 46 \u00b1 17 \u00b5Vs during LVSP to 38 \u00b1 15 \u00b5Vs during LBBP, while LVAT was not significantly different between LVSP and LBBP. In patients with normal ventricular activation and narrow QRS, QRS area during LBBP was not significantly different from that during intrinsic activation (37 \u00b1 16 vs. 35 \u00b1 19 \u00b5Vs, respectively). The Azimuth significantly changed from RVSP (\u221246 \u00b1 33\u00b0) to LVSP (19 \u00b1 16\u00b0) and LBBP (\u221222 \u00b1 14\u00b0). The Azimuth during both LVSP and LBBP were not significantly different from normal ventricular activation. QRS area and LVAT correlated moderately (Spearman\u2019s R = 0.58). Conclusions: ECG and VCG indices demonstrate that both LVSP and LBBP improve ventricular dyssynchrony considerably as compared to RVSP, to values close to normal ventricular activation. LBBP seems to result in a small, but significant, improvement in ventricular synchrony as compared to LVSP.<\/jats:p>","DOI":"10.3390\/jcm10040822","type":"journal-article","created":{"date-parts":[[2021,2,17]],"date-time":"2021-02-17T21:35:42Z","timestamp":1613597742000},"page":"822","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":59,"title":["Comparing Ventricular Synchrony in Left Bundle Branch and Left Ventricular Septal Pacing in Pacemaker Patients"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8539-3365","authenticated-orcid":false,"given":"Luuk I.B.","family":"Heckman","sequence":"first","affiliation":[{"name":"Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6200 MD Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin G.L.M.","family":"Luermans","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre + (MUMC+), 6229 HX Maastricht, The Netherlands"},{"name":"Department of Cardiology, Radboud University Medical Centre (Radboudumc), 6526 GA Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3523-6358","authenticated-orcid":false,"given":"Karol","family":"Curila","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 10034 Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonius M.W.","family":"Van Stipdonk","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre + (MUMC+), 6229 HX Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0165-6151","authenticated-orcid":false,"given":"Sjoerd","family":"Westra","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Radboud University Medical Centre (Radboudumc), 6526 GA Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0413-3604","authenticated-orcid":false,"given":"Radovan","family":"Smisek","sequence":"additional","affiliation":[{"name":"Institute of Scientific Instruments, the Czech Academy of Sciences, 61264 Brno, Czech Republic"},{"name":"Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Technick\u00e1 12, 61600 Brno, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frits W.","family":"Prinzen","sequence":"additional","affiliation":[{"name":"Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6200 MD Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Vernooy","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre + (MUMC+), 6229 HX Maastricht, The Netherlands"},{"name":"Department of Cardiology, Radboud University Medical Centre (Radboudumc), 6526 GA Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1161\/CIRCEP.109.882910","article-title":"Left ventricular septal and left ven-tricular apical pacing chronically maintain cardiac contractile coordination, pump function and efficiency","volume":"2","author":"Mills","year":"2009","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_2","first-page":"e003344","article-title":"Feasibility and Acute Hemodynamic Effect of Left Ventricular Septal Pacing by Transvenous Approach Through the Interventricular Septum","volume":"9","author":"Luermans","year":"2016","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1736.e1","DOI":"10.1016\/j.cjca.2017.09.013","article-title":"A Novel Pacing Strategy with Low and Stable Output: Pacing the Left Bundle Branch Immediately Beyond the Conduction Block","volume":"33","author":"Huang","year":"2017","journal-title":"Can. J. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1016\/j.jacep.2020.05.008","article-title":"Comparison of Left Bundle Branch and His Bundle Pacing in Bradycardia Patients","volume":"6","author":"Hua","year":"2020","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_5","first-page":"1694","article-title":"Feasibility and cardiac synchrony of permanent left bundle branch pacing through the interventricular septum","volume":"21","author":"Hou","year":"2019","journal-title":"EP Eur."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/j.jelectrocard.2015.04.001","article-title":"The synthesized vectorcardiogram resembles the measured vectorcardiogram in patients with dyssynchronous heart failure","volume":"48","author":"Engels","year":"2015","journal-title":"J. Electrocardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.hrthm.2015.07.033","article-title":"Vectorcardiographic QRS area identifies delayed left ventricular lateral wall activation determined by electroanatomic mapping in candidates for cardiac resynchronization therapy","volume":"13","author":"Wijntjens","year":"2016","journal-title":"Heart Rhythm."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e006497","DOI":"10.1161\/CIRCEP.118.006497","article-title":"QRS Area Is a Strong Determinant of Outcome in Cardiac Resynchronization Therapy","volume":"11","author":"Kloosterman","year":"2018","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1016\/j.hrthm.2019.06.016","article-title":"A beginner\u2019s guide to permanent left bundle branch pacing","volume":"16","author":"Huang","year":"2019","journal-title":"Hearth Rhythm."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1111\/jce.12549","article-title":"T-wave area predicts response to cardiac resyn-chronization therapy in patients with left bundle branch block","volume":"26","author":"Engels","year":"2015","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1093\/oxfordjournals.eurheartj.a059647","article-title":"Reconstruction of the Frank vectorcardiogram from standard electro-cardiographic leads: Diagnostic comparison of different methods","volume":"11","author":"Kors","year":"1990","journal-title":"Eur. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.ipej.2018.08.001","article-title":"Correlation of pacing site in right ventricle with paced QRS complex duration","volume":"18","author":"Gupta","year":"2018","journal-title":"Indian Pacing Electrophysiol. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1111\/jce.13045","article-title":"Longer Paced QRS Duration is Associated with Increased Prevalence of Right Ventricular Pacing-Induced Cardiomyopathy","volume":"27","author":"Khurshid","year":"2016","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1016\/j.hrthm.2014.05.040","article-title":"Incidence and predictors of right ventricular pacing-induced cardiomyopathy","volume":"11","author":"Khurshid","year":"2014","journal-title":"Heart Rhythm."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1016\/S0735-1097(03)00757-5","article-title":"A randomized comparison of atrial and dual-chamber pacing in 177 consecutive patients with sick sinus syndrome: Echocardiographic and clinical outcome","volume":"42","author":"Nielsen","year":"2003","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2932","DOI":"10.1161\/01.CIR.0000072769.17295.B1","article-title":"Adverse Effect of Ventricular Pacing on Heart Failure and Atrial Fibrillation Among Patients with Normal Baseline QRS Duration in a Clinical Trial of Pacemaker Therapy for Sinus Node Dysfunction","volume":"107","author":"Sweeney","year":"2003","journal-title":"Circulation"},{"key":"ref_17","first-page":"673","article-title":"Comparison of electrocardiogram characteristics and pacing parameters between left bundle branch pacing and right ventricular pacing in patients receiving pacemaker therapy","volume":"21","author":"Chen","year":"2018","journal-title":"EP Eur."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1111\/pace.13884","article-title":"Electrocardiographic morphology during left bundle branch area pacing: Characteristics, underlying mechanisms, and clinical implications","volume":"43","author":"Gao","year":"2020","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Jastrz\u0119bski, M., Kie\u0142basa, G., Moskal, P., Bednarek, A., Kusiak, A., Sondej, T., Bednarski, A., Rajzer, M., and Vijayaraman, P. (2020). Fixation beats: A novel marker for reaching the left bundle branch area during deep septal lead implantation. Heart Rhythm., online ahead of print.","DOI":"10.1101\/2020.10.04.20206573"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ghossein, M.A., van Stipdonk, A.M.W., Plesinger, F., Kloosterman, M., Wouters, P.C., Salden, O.A.E., Meine, M., Maass, A.H., Prinzen, F.W., and Vernooy, K. (2021). Reduction in the QRS area after cardiac resynchronization therapy is associated with survival and echocardiographic response. J. Cardiovasc. Electrophysiol.","DOI":"10.1093\/ehjci\/ehaa946.0814"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.1016\/j.hrthm.2019.04.043","article-title":"Permanent left bundle branch area pacing for atrioventricular block: Feasibility, safety, and acute effect","volume":"16","author":"Li","year":"2019","journal-title":"Heart Rhythm."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1111\/jce.14342","article-title":"Evaluation of cardiac synchrony in left bundle branch pacing: Insights from echocardiographic research","volume":"31","author":"Cai","year":"2020","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1093\/europace\/euy293","article-title":"Non-invasive electrocardiographic imaging of His-bundle and peri-left bundle pacing in left bundle branch block","volume":"21","author":"Chan","year":"2018","journal-title":"Europace"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.jacc.2019.11.040","article-title":"Short-Term Hemodynamic and Electrophysiological Effects of Cardiac Resynchronization by Left Ventricular Septal Pacing","volume":"75","author":"Salden","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1111\/jce.14299","article-title":"Novel ultra-high-frequency electrocardiogram tool for the description of the ventricular depolarization pattern before and during cardiac resynchronization","volume":"31","author":"Jurak","year":"2019","journal-title":"J. Cardiovasc. Electrophysiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/4\/822\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:25:22Z","timestamp":1760160322000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/4\/822"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,17]]},"references-count":25,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["jcm10040822"],"URL":"https:\/\/doi.org\/10.3390\/jcm10040822","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,17]]}}}