Clinical and Functional Impact of Bundle Branch Pacing in Ischemic Cardiomyopathy

Heart failure with reduced ejection fraction due to ischemic cardiomyopathy remains a major challenge. Electrical conduction delays worsen symptoms by causing uncoordi-nated contractions, inefficient pumping, and increased mortality. Right ventricular pacing exacerbates dyssynchrony, while resynchronization therapy improves outcomes but has a high non-responder rate. Bundle branch pacing engages the heart’s conduction system, restoring synchronized contraction and improving function. Objective: This re-view evaluates the impact of left bundle branch block-induced dyssynchrony, advanced imaging in assessing ventricular function, and clinical outcomes of bundle branch pacing in heart failure patients. Methods: We analyzed the mechanical and hemodynamic effects of left bundle branch block, imaging techniques for dyssynchrony assessment, and the clinical benefits of bundle branch pacing compared to resynchronization therapy. Results: Conduction delays impair function, increase stress, and worsen outcomes. Advanced imaging improves patient selection. Conduction system pacing restores coordination, enhances function, reduces hospitalizations, and promotes reverse remodeling. It offers similar or superior benefits to conventional resynchronization therapy, regulates stress hormones, reduces oxidative damage, and improves calcium handling. Conclusion: Bundle branch pacing advances heart failure treatment, but proper patient selection is crucial. Future research should refine implantation strategies and conduct large-scale trials to confirm long-term efficacy.