{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:20:26Z","timestamp":1790727626608,"version":"4.1.0"},"reference-count":44,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T00:00:00Z","timestamp":1745712000000},"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>Cardiac resynchronization therapy (CRT) using biventricular (BiV) pacing is the standard treatment for heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) and electrical dyssynchrony. However, one in three patients remains a non-responder. Left bundle branch area pacing (LBBAP) could represent a more physiological alternative, but its effectiveness is limited in cases of atypical left bundle branch block (LBBB) or intraventricular conduction delay (IVCD). Left Bundle Branch Pacing Optimized cardiac resynchronization therapy (LOT-CRT) integrates LBBAP with coronary sinus (CS) lead pacing to improve electrical synchrony and clinical outcomes. This review evaluates the feasibility, advantages, disadvantages, and clinical outcomes of LOT-CRT. Additionally, we describe our center\u2019s experience and propose an evidence-based implantation algorithm. A review of published studies investigating LOT-CRT was conducted, comparing its effectiveness with BiV-CRT and LBBAP alone using QRS narrowing, LVEF improvement, left ventricular remodeling, New York Heart Association (NYHA) class changes and NT-proBNP levels. It was found that LOT-CRT outperforms BiV-CRT or LBBAP alone in selected populations, at the cost of higher clinical skills, longer procedural times, and specific device setups. Randomized trials are underway to further define its role in clinical practice.<\/jats:p>","DOI":"10.3390\/jcm14093025","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T09:39:47Z","timestamp":1745833187000},"page":"3025","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Understanding LOT-CRT: Current Insights, Limitations, and Our Center\u2019s Experience"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3982-5101","authenticated-orcid":false,"given":"Georgios","family":"Leventopoulos","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University Hospital of Patras, 265 04 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kassiani-Maria","family":"Nastouli","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University Hospital of Patras, 265 04 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8215-427X","authenticated-orcid":false,"given":"Maria","family":"Bozika","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University Hospital of Patras, 265 04 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Papastavrou","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University Hospital of Patras, 265 04 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2616-7952","authenticated-orcid":false,"given":"Anastasios","family":"Apostolos","sequence":"additional","affiliation":[{"name":"First Department of Cardiology, Hippocration General Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6890-5127","authenticated-orcid":false,"given":"Rafail","family":"Koros","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University Hospital of Patras, 265 04 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelos","family":"Perperis","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University Hospital of Patras, 265 04 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioanna","family":"Koniari","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University Hospital of Patras, 265 04 Patras, Greece"},{"name":"Liverpool Centre for Cardiovascular Science, Liverpool L14 3PE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niki","family":"Vlassopoulou","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University Hospital of Patras, 265 04 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Chronopoulos","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University Hospital of Patras, 265 04 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7797-8141","authenticated-orcid":false,"given":"Christoforos K.","family":"Travlos","sequence":"additional","affiliation":[{"name":"Research Institute, McGill University Health Center, Montreal, QC H4A 3J1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0254-8657","authenticated-orcid":false,"given":"Athanasios","family":"Moulias","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University Hospital of Patras, 265 04 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Periklis","family":"Davlouros","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University Hospital of Patras, 265 04 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1093\/europace\/euaa067","article-title":"Adherence to ESC cardiac resynchronization therapy guidelines: Findings from the ESC CRT Survey II","volume":"22","author":"Normand","year":"2020","journal-title":"Europace"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1111\/j.1540-8159.2010.02882.x","article-title":"Site-specific differences in latency intervals during biventricular pacing: Impact on paced QRS morphology and echo-optimized V-V interval","volume":"33","author":"Herweg","year":"2010","journal-title":"Pacing Clin. 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