{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:09:53Z","timestamp":1792192193139,"version":"4.4.0"},"reference-count":32,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T00:00:00Z","timestamp":1766793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Culture and Innovation of Hungary from the National Research, Development and Innovation Fund","award":["TKP2021-EGA-18"],"award-info":[{"award-number":["TKP2021-EGA-18"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Conduction system pacing (CSP) is a potential alternative to biventricular pacing (BVP) in heart failure with reduced ejection fraction (HFrEF) and left bundle branch block (LBBB) or non-LBBB. Available data also suggest that unlike BVP, CSP may improve clinical outcome in patients with right bundle branch block (RBBB), although its effects on cardiac mechanics and energetics are ill-defined. Herein, we report on echocardiographic and clinical outcomes of CSP in this patient cohort. Methods: CSP either with His bundle pacing or LBB area pacing was attempted as a primary strategy in patients with RBBB, QRS duration \u2265 130 ms, LVEF &lt; 35% and NYHA II-IV symptoms after optimized medical therapy for 6 months. Data on functional status, NT-proBNP and echocardiographic parameters were collected at baseline and 6 months after CSP. Results: CSP performed in 16 patients reduced QRS duration from 155.3 \u00b1 12.8 ms to 130 \u00b1 16.5 ms (p &lt; 0.001), increased LVEF from 27 \u00b1 7% to 33 \u00b1 9% (p = 0.01), improved LV global longitudinal strain from \u22127 \u00b1 3% to \u221210 \u00b1 4% (p = 0.004) and improved LV peak strain dispersion from 126 \u00b1 28 ms to 96 \u00b1 23 ms (p = 0.004). Global myocardial work index increased from 582 \u00b1 277 mmHg% to 840 \u00b1 306 mmHg% (p = 0.003), as did global constructive work (900 \u00b1 374 mmHg% to 1203 \u00b1 393 mmHg%; p = 0.006) and global work efficiency (from 71 \u00b1 7% to 77 \u00b1 8%; p = 0.004). NYHA class (12.5% with NYHA II, 87.5% with NYHA III before vs. 25% with NYHA I, 50% with NYHA II and 25% with NYHA III at 6 months; p = 0.002) and 6 min walk distance (from 354 \u00b1 88 m to 411 \u00b1 95 m; p = 0.003) improved, while NT-proBNP decreased (from 4093 \u00b1 7215 ng\/L to 2087 \u00b1 2872 ng\/L, p = 0.003). Conclusions: CSP improved functional capacity and echocardiographic parameters related to cardiac functions and myocardial work in HFrEF patients with RBBB. Nevertheless, these results await further confirmation by large-scale, multi-center randomized trials.<\/jats:p>","DOI":"10.3390\/jcm15010232","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:50:42Z","timestamp":1766969442000},"page":"232","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Conduction System Pacing Improved Cardiac Functions, Myocardial Work and Functional Capacity in Heart Failure with Reduced Ejection Fraction and Right Bundle Branch Block"],"prefix":"10.3390","volume":"15","author":[{"given":"Anna Zs\u00f3fia","family":"T\u00f3th","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, M\u00f3ricz Zsigmond krt. 22., H-4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L\u00e1szl\u00f3","family":"Nagy","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, M\u00f3ricz Zsigmond krt. 22., H-4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9466-1413","authenticated-orcid":false,"given":"Csaba","family":"Jenei","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, M\u00f3ricz Zsigmond krt. 22., H-4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0616-8405","authenticated-orcid":false,"given":"Arnold P\u00e9ter","family":"R\u00e1duly","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, M\u00f3ricz Zsigmond krt. 22., H-4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00e1bor","family":"S\u00e1ndorfi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, M\u00f3ricz Zsigmond krt. 22., H-4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3206-6699","authenticated-orcid":false,"given":"Krisztina M\u00e1ria","family":"Szab\u00f3","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, M\u00f3ricz Zsigmond krt. 22., H-4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Kiss","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, M\u00f3ricz Zsigmond krt. 22., H-4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3067-3081","authenticated-orcid":false,"given":"L\u00e1szl\u00f3 Tibor","family":"Nagy","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, M\u00f3ricz Zsigmond krt. 22., H-4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerg\u0151 Istv\u00e1n","family":"Szil\u00e1gyi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, M\u00f3ricz Zsigmond krt. 22., H-4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zolt\u00e1n","family":"Csan\u00e1di","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, M\u00f3ricz Zsigmond krt. 22., H-4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1161\/CIRCULATIONAHA.122.062124","article-title":"Cardiac Resynchronization Therapy Improves Outcomes in Patients With Intraventricular Conduction Delay But Not Right Bundle Branch Block: A Patient-Level Meta-Analysis of Randomized Controlled Trials","volume":"147","author":"Friedman","year":"2023","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e006613","DOI":"10.1161\/CIRCEP.118.006613","article-title":"Permanent His Bundle Pacing for Cardiac Resynchronization Therapy in Patients With Heart Failure and Right Bundle Branch Block","volume":"11","author":"Sharma","year":"2018","journal-title":"Circ. 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