Effect of left bundle branch area pacing on cardiac remodeling and function: propensity score matching with right ventricular pacing

Effect of left bundle branch area pacing on cardiac remodeling and function: propensity score matching with right ventricular pacing | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of left bundle branch area pacing on cardiac remodeling and function: propensity score matching with right ventricular pacing Shigeng Zhang, Zongbin Li, Junfang Guo, Shengchan Wang, Zhixin Jiang, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6695039/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Nov, 2025 Read the published version in BMC Cardiovascular Disorders → Version 1 posted 10 You are reading this latest preprint version Abstract Background: Conventional right ventricular pacing (RVP) causes cardiac dyssynchrony, and increases risk of pacing-induced cardiomyopathy (PICM), heart failure hospitalization and mortality. Left bundle branch area pacing (LBBAP) is a promising physiological pacing modality, we compared the effect of LBBAP on cardiac function with RVP in patients with atrioventricular block (AVB). Methods: A total of 118 patients with AVB who successfully underwent LBBAP were enrolled between June 2019 and June 2022. Among them, 110 patients with a baseline LVEF≥50% were propensity-matched 1:1 with 49 patients who underwent RVP during the same period. Ultimately, 41 patients with well-matched baseline characteristics in both groups were included in the analysis. Echocardiographic parameters and NYHA classification at 1-year follow-up were compared between the groups. Results: Left ventricular ejection fraction (LVEF) remained stable in patients with LVEF≥50% (62.9±2.9 vs 62.9±3.3, P=0.960), and improved significantly in patients with LVEF<50% (58.0±9.9% vs 44.2±5.5%, P<0.05) at 1-year follow-up in the LBBAP group. Propensity score matching for baseline characteristics yielded 41 matched pairs. Changes in LVEF and left ventricular end-diastolic diameter (LVEDD) in the LBBAP group were significantly different from those in the RVP group: LVEF [-2.8(-5.0, -0.6), P=0.015] and LVEDD [1.3(0.1, 2.5), P=0.036], respectively. Compared with baseline, NYHA classification improved significantly in the LBBAP group (1.3 ±0.5 vs 1.0 ±0.2, P<0.05), while remained changed in the RVP group (1.3 ±0.4 vs 1.1 ±0.3, P=0.232). LBBAP showed a tendency to reduce PICM compared with RVP (0% vs 9.8%), though the difference was not significant (P=0.124). Conclusions: LBBAP might be a preferable pacing modality to improve cardiac remodeling and function in patients requiring high ventricular pacing burden compared with conventional RVP. left bundle branch area pacing right ventricular pacing atrioventricular block left ventricular ejection fraction pacing induced cardiomyopathy Figures Figure 1 Figure 2 Introduction Conventional right ventricular pacing (RVP) induces electrical and mechanical dyssynchrony[1], and is associated with increased incidence of mortality, heart failure hospitalization (HFH), atrial fibrillation (AF) and pacing-induced cardiomyopathy (PICM)[2-4]. Dutch FOLLOWPACE study showed that the risk of heart failure death increased by 8% at every 10% increase in RVP burden[5]. Most recent data suggest that the ventricular pacing threshold for HFH may be as low as 20%[6, 2]. His bundle pacing (HBP) can achieve an ideal physiological ventricular activation by directly engaging the conduction system. As compared with RVP, it can reduce the risks of HFH, upgrade to biventricular pacing (BiVP), and mortality[6, 7]. However, HBP has not been routinely used in clinical practice because of elevated threshold, high risk of lead dislocation and technical challenges[8]. Left bundle branch area pacing(LBBAP) has emerged recently[9] as an alternative physiological pacing strategy. Hou et.al[10] demonstrated by single photon emission computed tomography (SPECT) that LBBAP could achieve favorable cardiac electrical and left ventricular mechanical synchrony. Recent studies have shown that LBBAP could reduce the risk of HFH or upgrade to BiVP and improve left ventricular ejection fraction (LVEF) compared with RVP[11, 12], but only patients with LVEF ≥ 50% were recruited. The aim of this study is to compare the effect of LBBAP on cardiac function and risk of PICM with RVP in AVB patients with normal/impaired LVEF. Methods Study design This retrospective observational study was conducted at the First Affiliated Hospital of Nanjing Medical University, Nanjing; and the Affiliated People’s Hospital of Jiangsu University. Consecutive AVB patients with indications for ventricular pacing and successfully performed LBBAP were enrolled between June 2019 and June 2022（Figure1）. Pacing strategies resulted from consultation between physicians and patients. Patients were excluded if they (i) were younger than 18 years old; (ii) had severe valvular disease, congenital heart disease, or hypertrophic cardiomyopathy; (iii) had myocardial infarction or open heart surgery within the past 3 months; (iv) were not regularly followed up at the clinic visit; (v) underwent pacemaker replacement; (vi) were diagnosed with persistent atrial fibrillation. We also selected AVB patients successfully performed RVP during the same period. Propensity score matching was used to analyze differences between groups. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013) and approved by the Institutional Ethics Committees of these two hospitals, and all patients gave written informed consent before participating in this study. Implantation procedure The LBBAP procedure has been previously described in detail[13]. LBBAP was performed using the Select-Secure pacing lead (Mode 3830, 69cm; Medtronic) delivered through a fixed curve sheath (C315HIS; Medtronic). The delivered sheath was inserted into the right ventricle over a long guide wire through the subclavian or axillary vein, then the pacing lead was advanced through the sheath to the tip of the catheter. In order to identify the potential screwing site, a His bundle electrogram was identified first, and the system was advanced 1.0-2.0cm along an imaginary line between the His and the right ventricular apex. If the His bundle electrogram was difficult to identify, the nine-partition method was used[14]. Unipolar pacing was performed at an output of 2.0v/0.4ms before screwing, and the paced QRS complex in lead V1 always displayed a “W” morphology with a notch in the bottom. The lead then was inserted into the interventricular septum by clockwise rotations until the paced QRS morphology of right bundle branch block (RBBB) pattern in lead V1 or the premature ventricular contraction with RBBB pattern was present. Ring pacing or contrast media injection in the left anterior oblique 40° position was performed to evaluate the lead depth. The stimulus to left ventricular activation time (LVAT) was measured at low (2.0v/0.4ms) and high (5.0v/0.4ms) outputs in lead V 5-6 repeatedly. Left bundle branch pacing (LBBP) was considered successful if the paced QRS morphology presented with an RBBB pattern, and LVAT shortened abruptly by more than 10ms and keep shortest and constant at different outputs, or demonstration of transition from non-selective to selective LBBP/left ventricular(LV) capture during threshold testing(Figure2). If LBBP could not be successful after five attempts, the lead was then placed in the LV septum to achieve LV septal pacing. During RVP, the right ventricular lead was inserted in standard fashion into the right ventricular septum or apex based on operator preference. The atrioventricular (AV) delay was set as 120/90ms after LBBAP, and the automatic AV delay optimization algorithms were turned off. After RVP, however, the AV delay was set as 150/120ms, and automatic AV delay optimization algorithms were routinely turned on to avoid unnecessary ventricular pacing for patients with intermittent AVB. Data collection and follow-up Baseline demographics, medical history and current medication were collected. Patients underwent follow-up at 3, 6 and 12 months and annually after implantation. Pacing parameters were routinely documented. Echocardiographic measurements were conducted at baseline and 1 year after the procedure, Biplane Simpson’s method in two-dimensional transthoracic echocardiography was used for the evaluation of LVEF. PICM was defined as new-onset left ventricular systolic dysfunction (LVEF<50%) along with either (ⅰ) a ≥ 10% decrease in LVEF, or (ⅱ) new-onset regional wall motion abnormality unrelated to coronary artery disease with no other identifiable causes of LV dysfunction[15]. The primary outcome was changes in LVEF after 1 year, and RVP was compared with LBBAP. Secondary outcomes included changes in LVEDD, LAD and New York Heart Association (NYHA) functional class; the development of PICM. Statistical analysis Continuous data were summarized using mean±SD or median(interquartile range), categorical data were presented as frequency（percentage）. The c 2 or Fisher exact test was used to analyze categorical data. The Student’s t-test or the Kruskal-Wallis H test was used to analyze continuous data. Echocardiographic measurements were compared between groups with the analysis of covariance (ANCOVA), which took into account baseline values. Statistical significance was set at P < 0.05, all tests were 2 sided. Potential confounding factors including age, sex, baseline LVEF, LVEDD, QRSd and comorbidities were fit into a multivariable logistic model with a caliper as 0.05. Analysis were performed using SPSS version 26.0 (IBM Corporation, Armonk, NY, USA). Results Baseline characteristics of the subjects received LBBAP A total of 139 consecutive patients received LBBAP were enrolled, and at last 118 patients meeting final inclusion criteria were included in the analysis (Fig. 1 ). The mean age was 66.8 ± 14.4 years with males accounting for 55.9% of the study cohort. Prior history of heart failure and paroxysmal AF was present in 33.1% and 4.2%, respectively. Mean baseline LVEF of the entire cohort was 61.7 ± 5.7% and initial QRS duration was 118.7 ± 30.7ms. Eight patients (6.8%) in the cohort had LVEF < 50%, and heart failure prevalence, LVEF and LVEDD were different from patients with LVEF ≥ 50%. Baseline characteristics are summarized in Table 1 . Table 1 Baseline characteristics of the subjects received LBBAP Parameters Total(n = 118) EF ≥ 50%(n = 110) EF < 50%(n = 8) P Values Male, n(%) 66(55.9) 64(58.2) 2(25.0) 0.145 Age, y 66.8 ± 14.4 68.4 ± 13.0 57.3 ± 14.1 0.021 Hypertention, n(%) 71(60.2) 66 (60.0) 5(62.5) 1.000 Diabetes, n(%) 28(23.7) 27(24.5) 1(12.5) 0.732 CAD, n(%) 29(24.6) 28(25.5) 1(12.5) 0.692 Heart failure, n(%) 39(33.1) 31(28.2) 8(100) < 0.001 Paroxysmal AF, n(%) 5(4.2) 4(3.6) 1(12.5) 0.300 Βbloker, n(%) 33(28.0) 26(23.6) 7(87.5) 0.001 ACEI, n(%) 50(42.4) 44(40) 6(75.0) 0.118 LAD,mm 38.4 ± 4.7 38.4 ± 4.8 38 ± 6.4 0.839 LVEDD,mm 49.2 ± 5.4 49.0 ± 4.9 53.9 ± 10.3 0.015 LVEF, % 61.7 ± 5.7 62.9 ± 3.3 44.2 ± 5.5 < 0.001 Initial QRS duration, ms 118.7 ± 30.7 119.8 ± 29.9 140.5 ± 35.6 0.064 Paced QRS duration, ms 114.2 ± 11.3 115.6 ± 13.4 110.8 ± 10.5 0.325 LVAT, ms 76.6 ± 11.5 76.9 ± 11.5 76.3 ± 18.4 0.939 VP burden, % 95.5 ± 17.5 95.4 ± 18.0 97.5 ± 3.4 0.754 Values are mean ± SD(standard deviation), or number(%). P values, comparison between patients with LVEF ≥ 50% and LVEF < 50%; CAD = coronary artery disease; AF = atrial fibrillation; ACEI = angiotensin-converting enzyme inhibitor; LAD = left atrial diameter; LVEDD = left ventricular end-diastolic diameter; LVEF = left ventricular ejection fraction; LVAT = left ventricular activation time; VP = ventricular pacing. Pacing parameters and complications during follow-up The average VP burden was 95.5 ± 17.5%. The LBBAP capture threshold increased slightly during the follow-up period (0.58 ± 0.20 V/0.4ms vs 0.74 ± 0.19 V/0.4ms, P 1.00 V/0.4ms (1.23 ± 0.05 V/0.4ms), one patients with baseline LVEF<50%, three patients with baseline LVEF ≥ 50% (P = 0.248). The sensed R-wave amplitude rose (11.6 ± 3.8 V vs 13.7 ± 3.8 V, P < 0.05) and pacing impedance decreased (798.7 ± 173.9Ω vs 481.7 ± 85.4Ω, P < 0.05) significantly during follow-up. As shown in Table 2 , parameter changes of different groups based on LVEF were similar. The final unipolar paced QRSd was comparable to that at baseline (114.2 ± 11.3 ms vs 118.7 ± 30.7ms, P = 0.186). The mean LVAT was 76.6 ± 11.5ms. Paced QRSd (115.6 ± 13.4ms vs 110.8 ± 10.5ms, P = 0.325) and LVAT (76.9 ± 11.5ms vs 76.3 ± 18.4ms, P = 0.939) were similar between different groups (Table 1 ). Table 2 Pacing parameters in the LBBAP group during follow-up EF ≥ 50%(n = 110) EF < 50%(n = 8) P Values Baseline Follow-up Baseline Follow-up Capture Threshold (V/0.4ms) 0.58 ± 0.20 0.74 ± 0.19 # 0.70 ± 0.29 0.82 ± 0.24 # 0.901 R wave amplitude (mv) 11.8 ± 3.7 14.0 ± 3.3 # 9.4 ± 3.7 9.6 ± 7.0 0.215 Ventricular lead impedance (Ω) 789.8 ± 176.2 477.9 ± 183.4 # 821.6 ± 189.4 540.9 ± 101.1 # 0.884 Values are mean ± SD(standard deviation). # P < 0.05, when compared with baseline. P values, comparison of changes at follow-up and baseline between patients with LVEF ≥ 50% and LVEF < 50%; Three patients developed septal perforation during operation, and electrodes were implanted successfully after changing screw positions, no perforation occurred during follow-up. In one patient, there was loss of LBB capture, but maintained RV septal capture, with the paced QRS duration (QRSd) > 130ms and a QS pattern in lead V1. Pocket hematoma occurred in one patient before discharge, and improved after conservative treatment. There were no other postoperative complications related to LBBAP during the follow-up period. Improvement in echocardiographic measurements Compared with baseline, patients with LBBAP had improved LVEF (62.6 ± 3.9% vs 61.7 ± 5.9%, P = 0.045), significantly decreased LAD (37.0 ± 4.6mm vs 38.3 ± 4.9mm, P < 0.05) and LVEDD (47.8 ± 4.6mm vs 49.3 ± 5.5mm, P < 0.05) during 1-year follow-up. The mean LVEF increased from 44.2 ± 5.5% at baseline to 58.0 ± 9.9% during follow-up in eight patients with LVEF < 50%(P < 0.05); and remained unchanged in patients with LVEF ≥ 50% (62.9 ± 2.9vs 62.9 ± 3.3, P = 0.960). No patient developed PICM. As shown in Table 3 , changes of echocardiographic measurements were similar between groups, except for LVEF. Table 3 Echocardiographic measurements of AVB patients received LBBAP during follow-up EF ≥ 50%(n = 110) EF < 50%(n = 8) P Values Baseline Follow-up Baseline Follow-up LAD,mm 38.4 ± 4.8 37.1 ± 4.6 # 38.0 ± 6.4 36.4 ± 4.4 0.721 LVEDD,mm 49.0 ± 4.9 47.6 ± 3.9 # 53.9 ± 10.3 51.0 ± 9.4 0.638 LVEF,% 62.9 ± 3.3 62.9 ± 2.9 44.2 ± 5.5 58.0 ± 9.9 # 0.043 Values are mean ± SD(standard deviation). # P < 0.05, when compared with baseline. P values, comparison of changes at follow-up and baseline between patients with LVEF ≥ 50% and LVEF < 50%; Abbreviations as in Table 1 . Clinical outcomes during follow-up During the follow-up period, no patient died, and 2 patients (1.7%) suffered HFH, and got better with oral medications, both of which were diagnosed with heart failure with preserved ejection fraction preoperatively. Compared with baseline, both NYHA functional class (1.0 ± 0.2 vs 1.4 ± 0.6, P<0.05) and NT-proBNP level [154.2 (95.8, 545.0) pg/ml vs 415.5 (232.2, 1206.0) pg/ml, P<0.05] improved significantly. Propensity score matching analysis During the same period, 49 AVB patients with normal LVEF indicating for ventricular pacing underwent conventional RVP (32 paced from the right ventricular septum and 17 from the right ventricular apex), and were matched with 110 patients with normal LVEF (LVEF ≥ 50%) in the LBBAP group. Subsequently, propensity score matching identified 41 pairs of patients with balanced baseline characteristics (Table 4 ). Echocardiographic outcome, NYHA functional class and pacing parameters were analyzed in the propensity score matched cohort. Table 4 Baseline characteristics of the propensity score matched cohort LBBAP(n = 41) RVP(n = 41) P Age(y) 72.1 ± 12.0 72.8 ± 9.8 0.763 Male 22(53.7) 24(58.5) 0.656 Heart failure, n(%) 8(19.5) 7(17.1) 0.775 AF, n(%) 2(4.9) 1(2.4) 1.000 Hypertention, n(%) 30(73.2) 29(70.7) 0.806 CAD, n(%) 5(12.2) 6(14.6) 0.746 Diabetes, n(%) 7(17.1) 8(19.5) 0.775 LVEF(%) 63.0 ± 3.4 63.6 ± 4.0 0.427 LAD(mm) 38.3 ± 4.6 38.3 ± 5.1 0.964 LVEDD(mm) 48.3 ± 5.2 49.9 ± 4.8 0.154 Intrinsic QRSd(ms) 116.7 ± 30.5 113.9 ± 28.4 0.670 NYHA function class 1.3 ± 0.5 1.3 ± 0.4 0.862 βblocker 7(17.1) 6(14.6) 0.762 ACEI/ARB 22(53.7) 19(46.3) 0.508 Values are mean ± SD(standard deviation), or number(%). Abbreviations as in Table 1 . Electrophysiological and pacing parameters Table 5 shows the electrophysiological and pacing parameters for the propensity score matched cohort. Compared with RVP, LBBAP demonstrated narrower paced QRSd, lower acute pacing threshold, similar acute R wave amplitude and pacing impedance. At 1-year follow-up, the pacing threshold was comparable between the two groups. LBBAP showed higher ventricular pacing percentage (VP%) (97.3 ± 15.4% vs 86.9 ± 23.2%, P = 0.023), which maybe because the automatic AV delay optimization algorithms were turned off in this group. Table 5 Electrophysiological and pacing parameters LBBAP(n = 41) RVP(n = 41) P Baseline Sense(mv) 12.7 ± 5.1 11.8 ± 4.5 0.406 Threshold(v/0.4ms) 0.57 ± 0.16 0.84 ± 0.20 <0.001 Impedance(ꭥ) 803.8 ± 172.1 801.4 ± 176.6 0.952 Follow-up Sense(mv) 14.5 ± 4.3 10.9 ± 4.0 0.003 Threshold(v/0.4ms) 0.73 ± 0.19 0.75 ± 0.22 0.608 Impedance(ꭥ) 478.4 ± 83.3 529.4 ± 81.3 0.008 Paced QRSd(ms) 114.9 ± 11.7 167.5 ± 13.3 <0.001 VP(%) 97.3 ± 15.4 86.9 ± 23.2 0.023 Values are mean ± SD(standard deviation). Abbreviations as in Table 1 . Echocardiographic data and NYHA functional class Changes in LVEF and LVEDD were significantly different between treatment groups (Table 6 ). Compared with baseline, LBBAP induced decreased LAD, LVEDD, NYHA function class, and preserved LVEF at 1-year follow-up (P = 0.861). During a 1-year follow-up, 4 patients (9.8%) receiving RVP developed PICM, and none in patients with LBBAP, while the difference between groups showed no statistical significance(P = 0.124). Table 6 Changes of echocardiographic measurements and NYHA function class between LBBAP and RVP LBBAP RVP ANCOVA effect P LVEF(%) Baseline 63.0 ± 3.4 63.6 ± 4.0 -2.8(-5.0,-0.6) 0.015 1-year follow-up 63.1 ± 2.7 60.6 ± 7.1 # LAD(mm) Baseline 38.3 ± 4.6 38.3 ± 5.1 0.4(-1.0,1.7) 0.595 1-year follow-up 37.4 ± 4.1 # 37.8 ± 4.7 LVEDD(mm) Baseline 48.3 ± 5.2 49.9 ± 4.8 1.3(0.1,2.5) 0.036 1-year follow-up 47.1 ± 3.9 # 49.5 ± 4.6 NYHA Baseline 1.3 ± 0.5 1.3 ± 0.4 0.1(-0.1,0.2) 0.354 1-year follow-up 1.0 ± 0.2 # 1.1 ± 0.3 # Compared with baseline status, P < 0.05. Values are presented as mean ± SD. Abbreviations as in Table 1 . Discussion In the present study, we prospectively examined the effect of LBBAP on cardiac function in patients with AVB with normal/impaired LVEF, and provided a comparison between LBBAP and RVP using propensity score matching analysis. Main findings of this study are: (1) LBBAP preserved or improved LVEF in AVB patients with normal/impaired LVEF; (2) LBBAP preserved LVEF and improved LVEDD compared with RVP. Conventional RVP could induce electrical and mechanical ventricular dyssynchrony, leading to decreased cardiac function and increased mortality, HFH and PICM[ 2 – 4 , 1 ]. In recent years, BiVP has been proposed as an alternative to RVP in patients requiring high ventricular pacing rates. Three randomized trials have proved the superiority of BiVP over RVP in patients with moderate to severe systolic cardiac function[ 16 – 18 ], and BiVP is recommended in patients with AVB and LVEF < 50% to reduce total mortality and HF[ 19 ]. While, for patients with normal or preserved LVEF, data on benefit of BiVP are conflicting[ 20 , 21 ]. Because of higher costs and complications, clinical applications of BiVP have been limited. HBP could preserve ventricular synchrony[ 22 ], and improve clinical outcomes in patients with preserved LVEF compared with RVP. Kronborg et al.[ 7 ] found that HBP preserved LVEF and mechanical synchrony(55 ± 10% vs 50 ± 11%, P 40%. The study of Vijayaraman et al.[ 8 ] showed similar results, the LVEF remained unchanged in the HBP group(55 ± 8% vs 57 ± 6%, P = 0.13), whereas, significantly declined in the RVP group(57 ± 7% vs 52 ± 11%, P 40% ventricular pacing percentage (32% vs 43%,HR1.9, P = 0.04). Nevertheless, HBP has not become mainstream therapy clinically, because of technique challenges and higher pacing thresholds. As an alternative physiological pacing modality, LBBAP has been shown to preserve ventricular synchrony. Recent studies have demonstrated that the left ventricular synchrony of LBBAP is similar to that of native-conduction mode and superior to that of RVP[ 23 , 10 ]. Among AVB patients with LVEF ≥ 50%, Li et al.[ 12 ] found that patients with LBBAP had stable LVEF (62.6 ± 4.6% vs 61.7 ± 7.4%, P > 0.05) and slightly decreased LVEDD (49.4 ± 9.6 vs 46.6 ± 5.2mm, P < 0.05) compared with baseline at 1-year follow-up. The present study showed similar results, additionally, among patients with LVEF < 50%, LBBAP improved LVEF at 1-year follow-up. In the propensity score matching analysis, the comparison between LBBAP and RVP showed a significant difference in LVEF(P < 0.05) and LVEDD(P < 0.05). Compared with baseline, LBBAP improved NYHA functional class and NT-proBNP, whereas RVP did not showed similar effects, though changes between groups were not significantly different. PICM is not uncommon in patients with permanent pacemakers. The incidence of PICM varied from 9–26% depending on the definition of PICM and follow-up duration[ 24 ]. In this study, LBBAP showed a tendency to reduce PICM compared with RVP (0% vs 9.8%), though the difference was not significant. Given the small sample size of our study, clinical trials with larger sample size are needed to further evaluate the efficacy of LBBAP on PICM. Both BiVP and conduction system pacing are considered as physiological pacing modality. BiVP and HBP have been used for years in clinical practice, and showed beneficial effects on clinical outcomes. However, there are some defects, such as higher cost, lower procedure success rate, and increased capture threshold. Su et al.[ 25 ] found that LBBAP succeeded in 618/632 (97.8%) patients, and with a 0.69 ± 0.24 mv capture threshold at 2-year follow-up. Meanwhile, LBBAP showed a risk of complications similar to that of RVP (3.5% vs 1.3; P = 0.358) and significantly lower than did HBP (8.6% vs 1.3%; P = 0.034).[ 26 ] LBBAP would become the mainstream pacing modality in clinical pacing modality. Study Limitations This was a retrospective observational study in a single center, and the sample size was relatively small with only 8 patients having a baseline LVEF < 50%. LVEDD and LAD were compared between groups in the present study, while left ventricular volume and left atrial volume were not routinely measured. When comparing with the RVP group, we used propensity score matching to adjust for known confounders, however, there may be unknown and/or unmeasured confounders that affected. Future prospective randomized controlled trials with longer follow-up duration are needed. Conclusions LBBAP might be a preferable pacing modality to improve cardiac remodeling and function in patients requiring high ventricular pacing burden compared with conventional RVP. Declarations Conflict of interest: The authors declare that they have no conflict of interest. Acknowledgements None. Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be constructed as a potential conflict of interest. Clinical trial number Not applicable. Funding There was no funding. Ethics declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki (as revised in 2o13) and approved by the Ethics Committee of the Affiliated People’s Hospital of Jiangsu University and the Institutional Review Board of the First Affiliated Hospital of Nanjing Medical University, and all patients gave written informed consent before participating in this study. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Tops LF, Schalij MJ, Bax JJ. The Effects of Right Ventricular Apical Pacing on Ventricular Function and Dyssynchrony. J Am Coll Cardiol. 2009;54(9):764–76. Kiehl EL, Makki T, Kumar R, Gumber D, Kwon DH, Rickard JW, Kanj M, Wazni OM, Saliba WI, Varma N, Wilkoff BL, Cantillon DJ. Incidence and predictors of right ventricular pacing-induced cardiomyopathy in patients with complete atrioventricular block and preserved left ventricular systolic function. HEART RHYTHM. 2016;13(12):2272–8. Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, Lamas GA, Investigators MOST. 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. Circulation. 2003;107(23):2932–7. Tayal B, Fruelund P, Sogaard P, Riahi S, Polcwiartek C, Atwater BD, Gislason G, Risum N, Torp-Pedersen C, Kober L, Kragholm KH. Incidence of heart failure after pacemaker implantation: a nationwide Danish Registry-based follow-up study. Eur Heart J. 2019;40(44):3641–8. Udo EO, van Hemel NM, Zuithoff NPA, Doevendans PA, Moons KGM. Risk of heart failure- and cardiac death gradually increases with more right ventricular pacing. INT J CARDIOL. 2015;185:95–100. Abdelrahman M, Subzposh FA, Beer D, Durr B, Naperkowski A, Sun H, Oren JW, Dandamudi G, Vijayaraman P. Clinical Outcomes of His Bundle Pacing Compared to Right Ventricular Pacing. J Am Coll Cardiol. 2018;71(20):2319–30. Kronborg MB, Mortensen PT, Poulsen SH, Gerdes JC, Jensen HK, Nielsen JC. His or para-His pacing preserves left ventricular function in atrioventricular block: a double-blind, randomized, crossover study. EUROPACE. 2014;16(8):1189–96. Vijayaraman P, Naperkowski A, Subzposh FA, Abdelrahman M, Sharma PS, Oren JW, Dandamudi G, Ellenbogen KA. Permanent His-bundle pacing: Long-term lead performance and clinical outcomes. Heart Rhythm. 2018;15(5):696–702. Huang W, Su L, Wu S, Xu L, Xiao F, Zhou X, Ellenbogen KA. (2017) A Novel Pacing Strategy With Low and Stable Output: Pacing the Left Bundle Branch Immediately Beyond the Conduction Block. CAN J CARDIOL 33(12):1736.e1-1736.e3. Hou X, Qian Z, Wang Y, Qiu Y, Chen X, Jiang H, Jiang Z, Wu H, Zhao Z, Zhou W, Zou J. Feasibility and cardiac synchrony of permanent left bundle branch pacing through the interventricular septum. Europace. 2019;21(11):1694–702. Li X, Li H, Ma W, Ning X, Liang E, Pang K, Yao Y, Hua W, Zhang S, Fan X. Permanent left bundle branch area pacing for atrioventricular block: Feasibility, safety, and acute effect. HEART RHYTHM. 2019;16(12):1766–73. Li X, Zhang J, Qiu C, Wang Z, Li H, Pang K, Yao Y, Liu Z, Xie R, Chen Y, Wu Y, Fan X. Clinical Outcomes in Patients With Left Bundle Branch Area Pacing vs. Right Ventricular Pacing for Atrioventricular Block. Front Cardiovasc Med. 2021;8:685253. Huang W, Chen X, Su L, Wu S, Xia X, Vijayaraman P. A beginner's guide to permanent left bundle branch pacing. Heart Rhythm. 2019;16(12):1791–6. Jiang H, Hou X, Qian Z, Wang Y, Tang L, Qiu Y, Jiang Z, Chen X, Li K, Zou J. A novel 9-partition method using fluoroscopic images for guiding left bundle branch pacing. HEART RHYTHM. 2020;17(10):1759–67. Cho SW, Gwag HB, Hwang JK, Chun KJ, Park KM, On YK, Kim JS, Park SJ. Clinical features, predictors, and long-term prognosis of pacing‐induced cardiomyopathy. Eur J Heart Fail. 2019;21(5):643–51. Curtis AB, Worley SJ, Adamson PB, Chung ES, Niazi I, Sherfesee L, Shinn T, St M. (2013) Biventricular Pacing for Atrioventricular Block and Systolic Dysfunction. New Engl J Med 368(17):1585–1593. Kindermann M, Hennen B, Jung J, Geisel J, Böhm M, Fröhlig G. Biventricular versus conventional right ventricular stimulation for patients with standard pacing indication and left ventricular dysfunction -: The Homburg Biventricular Pacing Evaluation (HOBIPACE). J Am Coll Cardiol. 2006;47(10):1927–37. Martinelli Filho M, De Siqueira SF, Costa R, Greco OT, Moreira LF, D'Avila A, Heist EK. Conventional Versus Biventricular Pacing in Heart Failure and Bradyarrhythmia: The COMBAT Study. J CARD FAIL. 2010;16(4):293–300. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. Amer Coll C, Amer Heart Assoc Joint Comm C (2022) 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 79(17):e253-e421. Stockburger M, Gómez-Doblas JJ, Lamas G, Alzueta J, Fernández‐Lozano I, Cobo E, Wiegand U, Concha JF, Navarro X, Navarro‐López F, de Teresa E. Preventing ventricular dysfunction in pacemaker patients without advanced heart failure: results from a multicentre international randomized trial (PREVENT‐HF). Eur J Heart Fail. 2011;13(6):633–41. Yu CM, Fang F, Luo XX, Zhang Q, Azlan H, Razali O. Long-term follow‐up results of the Pacing to Avoid Cardiac Enlargement (PACE) trial. Eur J Heart Fail. 2014;16(9):1016–25. Zhang J, Guo J, Hou X, Wang Y, Qian Z, Li K, Ge P, Zou J. Comparison of the effects of selective and non-selective His bundle pacing on cardiac electrical and mechanical synchrony. EUROPACE. 2018;20(6):1010–7. Cai B, Huang X, Li L, Guo J, Chen S, Meng F, Wang H, Lin B, Su M. Evaluation of cardiac synchrony in left bundle branch pacing: Insights from echocardiographic research. J Cardiovasc Electr. 2020;31(2):560–9. Cho SW, Bin Gwag H, Hwang JK, Chun KJ, Park K-M, On YK, Kim JS, Park S-J. Clinical features, predictors, and long-term prognosis of pacing-induced cardiomyopathy. EUR J HEART FAIL. 2019;21(5):643–51. Su L, Wang S, Wu S, Xu L, Huang Z, Chen X, Zheng R, Jiang L, Ellenbogen KA, Whinnett ZI, Huang W. Long-Term Safety and Feasibility of Left Bundle Branch Pacing in a Large Single-Center Study. Circ- Arrhythm Electrophysiol. 2021;14(2):e009251. Palmisano P, Ziacchi M, Dell’Era G, Donateo P, Ammendola E, Coluccia G, Guido A, Piemontese GP, Lazzeri M, Ghiglieno C, Veroli A, Maggi R, Russo V, Rago A, Nigro G, Senes J, Patti G, Biffi M, Accogli M. Rate and nature of complications of conduction system pacing compared with right ventricular pacing: Results of a propensity score–matched analysis from a multicenter registry. Heart Rhythm. 2023;20(7):984–91. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 28 Nov, 2025 Read the published version in BMC Cardiovascular Disorders → Version 1 posted Editorial decision: Revision requested 19 Aug, 2025 Reviews received at journal 18 Aug, 2025 Reviews received at journal 04 Aug, 2025 Reviewers agreed at journal 31 Jul, 2025 Reviewers agreed at journal 30 Jul, 2025 Reviewers invited by journal 30 Jul, 2025 Editor assigned by journal 30 Jul, 2025 Editor invited by journal 28 Jul, 2025 Submission checks completed at journal 25 Jul, 2025 First submitted to journal 25 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6695039","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":493756015,"identity":"d4d5c597-02e4-4efd-8ecb-cec5a8b3ec3a","order_by":0,"name":"Shigeng Zhang","email":"","orcid":"","institution":"The First Clinical Medical School of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shigeng","middleName":"","lastName":"Zhang","suffix":""},{"id":493756017,"identity":"979f438e-033f-4445-bac4-188c56147496","order_by":1,"name":"Zongbin Li","email":"","orcid":"","institution":"The First Clinical Medical School of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zongbin","middleName":"","lastName":"Li","suffix":""},{"id":493756018,"identity":"46ccb6b4-1a16-470d-9c27-cf4afb5c1032","order_by":2,"name":"Junfang Guo","email":"","orcid":"","institution":"The Affiliated People’s Hospital of Jiangsu University","correspondingAuthor":false,"prefix":"","firstName":"Junfang","middleName":"","lastName":"Guo","suffix":""},{"id":493756019,"identity":"2edaebc7-a4e4-470e-9df7-ea51b2328bfb","order_by":3,"name":"Shengchan Wang","email":"","orcid":"","institution":"The First Clinical Medical School of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shengchan","middleName":"","lastName":"Wang","suffix":""},{"id":493756020,"identity":"991b51b1-1871-43b3-a474-64f03150806e","order_by":4,"name":"Zhixin Jiang","email":"","orcid":"","institution":"The First Affiliated Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhixin","middleName":"","lastName":"Jiang","suffix":""},{"id":493756021,"identity":"9cdbe4a4-5a6d-4f4c-9d57-663d633883ed","order_by":5,"name":"Wen Yang","email":"","orcid":"","institution":"The First Affiliated Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wen","middleName":"","lastName":"Yang","suffix":""},{"id":493756022,"identity":"155fe257-3507-4253-8b6a-ddb84e6b3b1f","order_by":6,"name":"Yandi Cheng","email":"","orcid":"","institution":"The First Clinical Medical School of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yandi","middleName":"","lastName":"Cheng","suffix":""},{"id":493756023,"identity":"4878cc53-c40e-4fcd-a6a6-211f95aa7977","order_by":7,"name":"Xiujuan Zhou","email":"","orcid":"","institution":"The First Affiliated Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiujuan","middleName":"","lastName":"Zhou","suffix":""},{"id":493756024,"identity":"4b01f1f9-3fd2-45eb-adbc-91a161e08c88","order_by":8,"name":"Qijun Shan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYFCCA2xAwoaBsQHEYSNeSxpJWsDKDiOxCQG+g8efPfi543we87QzBgwfyg4z8M9uwK9F8sAZc8PeM7eLGWfnGDDOOHeYQeLOAfxaDA6cYZPgbbud2AjUwszbdpjBQCKBkJbjzyT/tp2DaPlLnJYDZtK8bQcgWhiJ0QL0i5m0bFsyUEtawcGec+k8EjcIaOG7AXTY2za7xI2zkzc++FFmLcc/g4AWhhsHILRhAzBWgTQPAfVAcL4BQssTVjoKRsEoGAUjFQAA5epKWUCM77EAAAAASUVORK5CYII=","orcid":"","institution":"The First Affiliated Hospital of Nanjing Medical University","correspondingAuthor":true,"prefix":"","firstName":"Qijun","middleName":"","lastName":"Shan","suffix":""}],"badges":[],"createdAt":"2025-05-19 04:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6695039/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6695039/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12872-025-05334-y","type":"published","date":"2025-11-28T15:57:20+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88236926,"identity":"8c0444d2-1a4b-4ae6-bbd3-94265b54e4bd","added_by":"auto","created_at":"2025-08-04 10:30:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":152267,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the study population enrollment. AVB=atrioventricular block; LBBAP=left bundle branch area pacing; RVP=right ventricular pacing; LVEF=left ventricular ejection fraction; LVEDD=left ventricular end diastolic diameter; QRSd=QRS duration; AF=atrial fibrillation\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6695039/v1/11704440f1d80f5e2301137a.png"},{"id":88236009,"identity":"294bc984-0adf-48cc-9e77-e7a370cced51","added_by":"auto","created_at":"2025-08-04 10:22:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":249584,"visible":true,"origin":"","legend":"\u003cp\u003eFluoroscopic images of pacing lead and electrocardiographic(ECG) characteristics of LBBAP. \u003cstrong\u003ea\u003c/strong\u003e: Intrinsic rhythm(initial QRSd=94ms); \u003cstrong\u003eb\u003c/strong\u003e: Pacing with the lead tip on the right side of the septum; \u003cstrong\u003ec\u003c/strong\u003e: Pacing with the lead tip on the left side of the septum(S-LVAT=82ms, without capture of LBB); \u003cstrong\u003ed\u003c/strong\u003e,\u003cstrong\u003ee\u003c/strong\u003e: Capture of the LBB(S-LVAT=71ms, constant and shortest at different outputs. \u003cstrong\u003ed\u003c/strong\u003e, output at 5V/0.4ms; \u003cstrong\u003ee\u003c/strong\u003e, output at 2V/0.4ms); \u003cstrong\u003ef\u003c/strong\u003e: Fluoroscopic image of LBBAP lead position and contrast media injection.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6695039/v1/6849ba574f08bc882defa5be.png"},{"id":97179377,"identity":"41fcbb1f-90ca-4fb0-86cc-8cc04a30c9c1","added_by":"auto","created_at":"2025-12-01 16:15:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1310846,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6695039/v1/8590768b-086d-4cf9-8dab-911df21b37fd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of left bundle branch area pacing on cardiac remodeling and function: propensity score matching with right ventricular pacing","fulltext":[{"header":"Introduction","content":"\u003cp\u003eConventional right ventricular pacing (RVP) induces electrical and mechanical dyssynchrony[1], and is associated with increased incidence of mortality, heart failure hospitalization (HFH), atrial fibrillation (AF) and pacing-induced cardiomyopathy (PICM)[2-4]. Dutch FOLLOWPACE study showed that the risk of heart failure death increased by 8% at every 10% increase in RVP burden[5]. Most recent data suggest that the ventricular pacing threshold for HFH may be as low as 20%[6, 2].\u003c/p\u003e\n\u003cp\u003eHis bundle pacing (HBP) can achieve an ideal physiological ventricular activation by directly engaging the conduction system. As compared with RVP, it can reduce the risks of HFH, upgrade to biventricular pacing (BiVP), and mortality[6, 7]. However, HBP has not been routinely used in clinical practice because of elevated threshold, high risk of lead dislocation and technical challenges[8]. Left bundle branch area pacing(LBBAP) has emerged recently[9] as an alternative physiological pacing strategy. Hou et.al[10] demonstrated by single photon emission computed tomography (SPECT) that LBBAP could achieve favorable cardiac electrical and left ventricular mechanical synchrony. Recent studies have shown that LBBAP could reduce the risk of HFH or upgrade to BiVP and improve left ventricular ejection fraction (LVEF) compared with RVP[11, 12], but only patients with LVEF ≥ 50% were recruited. The aim of this study is to compare the effect of LBBAP on cardiac function and risk of PICM with RVP in AVB patients with normal/impaired LVEF.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective observational study was conducted at the First Affiliated Hospital of Nanjing Medical University, Nanjing; and the Affiliated People\u0026rsquo;s Hospital of Jiangsu University. Consecutive AVB patients with indications for ventricular pacing and successfully performed LBBAP were enrolled between June 2019 and June 2022（Figure1）. Pacing strategies resulted from consultation between physicians and patients. Patients were excluded if they (i) were younger than 18 years old; (ii) had severe valvular disease, congenital heart disease, or hypertrophic cardiomyopathy; (iii) had myocardial infarction or open heart surgery within the past 3 months; (iv) were not regularly followed up at the clinic visit; (v) underwent pacemaker replacement; (vi) were diagnosed with persistent atrial fibrillation. We also selected AVB patients successfully performed RVP during the same period. Propensity score matching was used to analyze differences between groups. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013) and approved by the Institutional Ethics Committees of these two hospitals, and all patients gave written informed consent before participating in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplantation procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe LBBAP procedure has been previously described in detail[13]. LBBAP was performed using the Select-Secure pacing lead (Mode 3830, 69cm; Medtronic) delivered through a fixed curve sheath (C315HIS; Medtronic). The delivered sheath was inserted into the right ventricle over a long guide wire through the subclavian or axillary vein, then the pacing lead was advanced through the sheath to the tip of the catheter. In order to identify the potential screwing site, a His bundle electrogram was identified first, and the system was advanced 1.0-2.0cm along an imaginary line between the His and the right ventricular apex. If the His bundle electrogram was difficult to identify, the nine-partition method was used[14]. Unipolar pacing was performed at an output of 2.0v/0.4ms before screwing, and the paced QRS complex in lead V1 always displayed a \u0026ldquo;W\u0026rdquo; morphology with a notch in the bottom. The lead then was inserted into the interventricular septum by clockwise rotations until the paced QRS morphology of right bundle branch block (RBBB) pattern in lead V1 or the premature ventricular contraction with RBBB pattern was present. Ring pacing or contrast media injection in the left anterior oblique 40\u0026deg; position was performed to evaluate the lead depth. The stimulus to left ventricular activation time (LVAT) was measured at low (2.0v/0.4ms) and high (5.0v/0.4ms) outputs in lead V\u003csub\u003e5-6\u003c/sub\u003e repeatedly. Left bundle branch pacing (LBBP) was considered successful if the paced QRS morphology presented with an RBBB pattern, and LVAT shortened abruptly by more than 10ms and keep shortest and constant at different outputs, or demonstration of transition from non-selective to selective LBBP/left ventricular(LV) capture during threshold testing(Figure2). If LBBP could not be successful after five attempts, the lead was then placed in the LV septum to achieve LV septal pacing.\u0026nbsp;During RVP, the\u0026nbsp;right ventricular lead was inserted in standard fashion into the right ventricular septum or apex based on operator preference.\u003c/p\u003e\n\u003cp\u003eThe atrioventricular (AV) delay was set as 120/90ms after LBBAP, and the automatic AV delay optimization algorithms were turned off. After RVP, however, the AV delay was set as 150/120ms, and automatic AV delay optimization algorithms were routinely turned on to avoid unnecessary ventricular pacing for patients with intermittent AVB.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection and follow-up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBaseline demographics, medical history and current medication were collected. Patients underwent follow-up at 3, 6 and 12 months and annually after implantation. Pacing parameters were routinely documented. Echocardiographic measurements were conducted at baseline and 1 year after the procedure, Biplane Simpson\u0026rsquo;s method in two-dimensional transthoracic echocardiography was used for the evaluation of LVEF. PICM was defined as new-onset left ventricular systolic dysfunction (LVEF\u0026lt;50%) along with either (ⅰ) a \u0026ge; 10% decrease in LVEF, or (ⅱ) new-onset regional wall motion abnormality unrelated to coronary artery disease with no other identifiable causes of LV dysfunction[15].\u003c/p\u003e\n\u003cp\u003eThe primary outcome was changes in LVEF after 1 year, and RVP was compared with LBBAP. Secondary outcomes included changes in LVEDD, LAD and New York Heart Association (NYHA) functional class; the development of PICM.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eContinuous data were summarized using mean\u0026plusmn;SD or median(interquartile range), categorical data were presented as frequency（percentage）. The \u0026nbsp;c\u003csup\u003e2\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eor Fisher exact test was used to analyze categorical data. The Student\u0026rsquo;s t-test or the Kruskal-Wallis H test was used to analyze continuous data. Echocardiographic measurements were compared between groups with the analysis of covariance (ANCOVA), which took into account baseline values. Statistical significance was set at P \u0026lt; 0.05, all tests were 2 sided. Potential confounding factors including age, sex, baseline LVEF, LVEDD, QRSd and comorbidities were fit into a multivariable logistic model with a caliper as 0.05. Analysis were performed using SPSS version 26.0 (IBM Corporation, Armonk, NY, USA).\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eBaseline characteristics of the subjects received LBBAP\u003c/b\u003e\u003c/p\u003e\u003cp\u003e A total of 139 consecutive patients received LBBAP were enrolled, and at last 118 patients meeting final inclusion criteria were included in the analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean age was 66.8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.4 years with males accounting for 55.9% of the study cohort. Prior history of heart failure and paroxysmal AF was present in 33.1% and 4.2%, respectively. Mean baseline LVEF of the entire cohort was 61.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7% and initial QRS duration was 118.7\u0026thinsp;\u0026plusmn;\u0026thinsp;30.7ms. Eight patients (6.8%) in the cohort had LVEF\u0026thinsp;\u0026lt;\u0026thinsp;50%, and heart failure prevalence, LVEF and LVEDD were different from patients with LVEF\u0026thinsp;\u0026ge;\u0026thinsp;50%. Baseline characteristics are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics of the subjects received LBBAP\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameters\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal(n\u0026thinsp;=\u0026thinsp;118)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEF\u0026thinsp;\u0026ge;\u0026thinsp;50%(n\u0026thinsp;=\u0026thinsp;110)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEF\u0026thinsp;\u0026lt;\u0026thinsp;50%(n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP Values\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e66(55.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64(58.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.145\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e66.8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68.4\u0026thinsp;\u0026plusmn;\u0026thinsp;13.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57.3\u0026thinsp;\u0026plusmn;\u0026thinsp;14.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertention, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e71(60.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66 (60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5(62.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28(23.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27(24.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.732\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCAD, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29(24.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28(25.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.692\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeart failure, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39(33.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31(28.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParoxysmal AF, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5(4.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(3.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.300\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eΒbloker, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33(28.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26(23.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(87.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eACEI, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50(42.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44(40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(75.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.118\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLAD,mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.839\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLVEDD,mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLVEF, %\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e61.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInitial QRS duration, ms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e118.7\u0026thinsp;\u0026plusmn;\u0026thinsp;30.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e119.8\u0026thinsp;\u0026plusmn;\u0026thinsp;29.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e140.5\u0026thinsp;\u0026plusmn;\u0026thinsp;35.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.064\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePaced QRS duration, ms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e114.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e115.6\u0026thinsp;\u0026plusmn;\u0026thinsp;13.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e110.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.325\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLVAT, ms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e76.6\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76.3\u0026thinsp;\u0026plusmn;\u0026thinsp;18.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.939\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVP burden, %\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e95.5\u0026thinsp;\u0026plusmn;\u0026thinsp;17.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95.4\u0026thinsp;\u0026plusmn;\u0026thinsp;18.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.754\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eValues are mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD(standard deviation), or number(%).\u003c/p\u003e\u003cp\u003eP values, comparison between patients with LVEF\u0026thinsp;\u0026ge;\u0026thinsp;50% and LVEF\u0026thinsp;\u0026lt;\u0026thinsp;50%;\u003c/p\u003e\u003cp\u003eCAD\u0026thinsp;=\u0026thinsp;coronary artery disease; AF\u0026thinsp;=\u0026thinsp;atrial fibrillation; ACEI\u0026thinsp;=\u0026thinsp;angiotensin-converting enzyme inhibitor; LAD\u0026thinsp;=\u0026thinsp;left atrial diameter; LVEDD\u0026thinsp;=\u0026thinsp;left ventricular end-diastolic diameter; LVEF\u0026thinsp;=\u0026thinsp;left ventricular ejection fraction; LVAT\u0026thinsp;=\u0026thinsp;left ventricular activation time; VP\u0026thinsp;=\u0026thinsp;ventricular pacing.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePacing parameters and complications during follow-up\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe average VP burden was 95.5\u0026thinsp;\u0026plusmn;\u0026thinsp;17.5%. The LBBAP capture threshold increased slightly during the follow-up period (0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20 V/0.4ms vs 0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19 V/0.4ms, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). At 12-months follow-up, four patients (3.4%) had capture threshold\u0026thinsp;\u0026gt;\u0026thinsp;1.00 V/0.4ms (1.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05 V/0.4ms), one patients with baseline LVEF\u0026lt;50%, three patients with baseline LVEF\u0026thinsp;\u0026ge;\u0026thinsp;50% (P\u0026thinsp;=\u0026thinsp;0.248). The sensed R-wave amplitude rose (11.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8 V vs 13.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8 V, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and pacing impedance decreased (798.7\u0026thinsp;\u0026plusmn;\u0026thinsp;173.9Ω vs 481.7\u0026thinsp;\u0026plusmn;\u0026thinsp;85.4Ω, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) significantly during follow-up. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, parameter changes of different groups based on LVEF were similar. The final unipolar paced QRSd was comparable to that at baseline (114.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.3 ms vs 118.7\u0026thinsp;\u0026plusmn;\u0026thinsp;30.7ms, P\u0026thinsp;=\u0026thinsp;0.186). The mean LVAT was 76.6\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5ms. Paced QRSd (115.6\u0026thinsp;\u0026plusmn;\u0026thinsp;13.4ms vs 110.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5ms, P\u0026thinsp;=\u0026thinsp;0.325) and LVAT (76.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5ms vs 76.3\u0026thinsp;\u0026plusmn;\u0026thinsp;18.4ms, P\u0026thinsp;=\u0026thinsp;0.939) were similar between different groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePacing parameters in the LBBAP group during follow-up\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eEF\u0026thinsp;\u0026ge;\u0026thinsp;50%(n\u0026thinsp;=\u0026thinsp;110)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eEF\u0026thinsp;\u0026lt;\u0026thinsp;50%(n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP Values\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFollow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFollow-up\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCapture Threshold\u003c/p\u003e\u003cp\u003e(V/0.4ms)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e0.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e0.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.901\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eR wave amplitude (mv)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e11.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e14.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e9.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e9.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.215\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVentricular lead impedance (Ω)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e789.8\u0026thinsp;\u0026plusmn;\u0026thinsp;176.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e477.9\u0026thinsp;\u0026plusmn;\u0026thinsp;183.4\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e821.6\u0026thinsp;\u0026plusmn;\u0026thinsp;189.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e540.9\u0026thinsp;\u0026plusmn;\u0026thinsp;101.1\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.884\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eValues are mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD(standard deviation).\u003c/p\u003e\u003cp\u003e\u003csup\u003e#\u003c/sup\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05, when compared with baseline.\u003c/p\u003e\u003cp\u003eP values, comparison of changes at follow-up and baseline between patients with LVEF\u0026thinsp;\u0026ge;\u0026thinsp;50% and LVEF\u0026thinsp;\u0026lt;\u0026thinsp;50%;\u003c/p\u003e\u003cp\u003eThree patients developed septal perforation during operation, and electrodes were implanted successfully after changing screw positions, no perforation occurred during follow-up. In one patient, there was loss of LBB capture, but maintained RV septal capture, with the paced QRS duration (QRSd)\u0026thinsp;\u0026gt;\u0026thinsp;130ms and a QS pattern in lead V1. Pocket hematoma occurred in one patient before discharge, and improved after conservative treatment. There were no other postoperative complications related to LBBAP during the follow-up period.\u003c/p\u003e\u003cp\u003e\u003cb\u003eImprovement in echocardiographic measurements\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCompared with baseline, patients with LBBAP had improved LVEF (62.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9% vs 61.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9%, P\u0026thinsp;=\u0026thinsp;0.045), significantly decreased LAD (37.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6mm vs 38.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9mm, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and LVEDD (47.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6mm vs 49.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5mm, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) during 1-year follow-up. The mean LVEF increased from 44.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5% at baseline to 58.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9% during follow-up in eight patients with LVEF\u0026thinsp;\u0026lt;\u0026thinsp;50%(P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); and remained unchanged in patients with LVEF\u0026thinsp;\u0026ge;\u0026thinsp;50% (62.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9vs 62.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3, P\u0026thinsp;=\u0026thinsp;0.960). No patient developed PICM. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, changes of echocardiographic measurements were similar between groups, except for LVEF.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEchocardiographic measurements of AVB patients received LBBAP during follow-up\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eEF\u0026thinsp;\u0026ge;\u0026thinsp;50%(n\u0026thinsp;=\u0026thinsp;110)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eEF\u0026thinsp;\u0026lt;\u0026thinsp;50%(n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP Values\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFollow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFollow-up\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLAD,mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e38.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e37.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e38.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e36.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.721\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLVEDD,mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e49.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e47.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e53.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e51.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.638\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLVEF,%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e62.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e62.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e44.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e58.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.043\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eValues are mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD(standard deviation).\u003c/p\u003e\u003cp\u003e\u003csup\u003e#\u003c/sup\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05, when compared with baseline.\u003c/p\u003e\u003cp\u003eP values, comparison of changes at follow-up and baseline between patients with LVEF\u0026thinsp;\u0026ge;\u0026thinsp;50% and LVEF\u0026thinsp;\u0026lt;\u0026thinsp;50%;\u003c/p\u003e\u003cp\u003eAbbreviations\u003c/p\u003e\u003cp\u003eas in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eClinical outcomes during follow-up\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDuring the follow-up period, no patient died, and 2 patients (1.7%) suffered HFH, and got better with oral medications, both of which were diagnosed with heart failure with preserved ejection fraction preoperatively. Compared with baseline, both NYHA functional class (1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 vs 1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6, P\u0026lt;0.05) and NT-proBNP level [154.2 (95.8, 545.0) pg/ml vs 415.5 (232.2, 1206.0) pg/ml, P\u0026lt;0.05] improved significantly.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePropensity score matching analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDuring the same period, 49 AVB patients with normal LVEF indicating for ventricular pacing underwent conventional RVP (32 paced from the right ventricular septum and 17 from the right ventricular apex), and were matched with 110 patients with normal LVEF (LVEF\u0026thinsp;\u0026ge;\u0026thinsp;50%) in the LBBAP group. Subsequently, propensity score matching identified 41 pairs of patients with balanced baseline characteristics (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Echocardiographic outcome, NYHA functional class and pacing parameters were analyzed in the propensity score matched cohort.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics of the propensity score matched cohort\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLBBAP(n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRVP(n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge(y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72.1\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.763\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22(53.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24(58.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.656\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeart failure, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(19.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.775\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAF, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2(4.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertention, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30(73.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29(70.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.806\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCAD, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5(12.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(14.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.746\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7(17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(19.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.775\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLVEF(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.427\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLAD(mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.964\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLVEDD(mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.154\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntrinsic QRSd(ms)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e116.7\u0026thinsp;\u0026plusmn;\u0026thinsp;30.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e113.9\u0026thinsp;\u0026plusmn;\u0026thinsp;28.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.670\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNYHA function class\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.862\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eβblocker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7(17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(14.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.762\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eACEI/ARB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22(53.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19(46.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.508\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eValues are mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD(standard deviation), or number(%).\u003c/p\u003e\u003cp\u003eAbbreviations as in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eElectrophysiological and pacing parameters\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows the electrophysiological and pacing parameters for the propensity score matched cohort. Compared with RVP, LBBAP demonstrated narrower paced QRSd, lower acute pacing threshold, similar acute R wave amplitude and pacing impedance. At 1-year follow-up, the pacing threshold was comparable between the two groups. LBBAP showed higher ventricular pacing percentage (VP%) (97.3\u0026thinsp;\u0026plusmn;\u0026thinsp;15.4% vs 86.9\u0026thinsp;\u0026plusmn;\u0026thinsp;23.2%, P\u0026thinsp;=\u0026thinsp;0.023), which maybe because the automatic AV delay optimization algorithms were turned off in this group.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eElectrophysiological and pacing parameters\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLBBAP(n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRVP(n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBaseline\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSense(mv)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e12.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e11.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.406\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThreshold(v/0.4ms)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImpedance(ꭥ)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e803.8\u0026thinsp;\u0026plusmn;\u0026thinsp;172.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e801.4\u0026thinsp;\u0026plusmn;\u0026thinsp;176.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.952\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFollow-up\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSense(mv)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e10.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThreshold(v/0.4ms)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.608\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImpedance(ꭥ)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e478.4\u0026thinsp;\u0026plusmn;\u0026thinsp;83.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e529.4\u0026thinsp;\u0026plusmn;\u0026thinsp;81.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePaced QRSd(ms)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e114.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e167.5\u0026thinsp;\u0026plusmn;\u0026thinsp;13.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVP(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e97.3\u0026thinsp;\u0026plusmn;\u0026thinsp;15.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e86.9\u0026thinsp;\u0026plusmn;\u0026thinsp;23.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.023\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eValues are mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD(standard deviation).\u003c/p\u003e\u003cp\u003eAbbreviations as in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEchocardiographic data and NYHA functional class\u003c/b\u003e\u003c/p\u003e\u003cp\u003eChanges in LVEF and LVEDD were significantly different between treatment groups (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). Compared with baseline, LBBAP induced decreased LAD, LVEDD, NYHA function class, and preserved LVEF at 1-year follow-up (P\u0026thinsp;=\u0026thinsp;0.861). During a 1-year follow-up, 4 patients (9.8%) receiving RVP developed PICM, and none in patients with LBBAP, while the difference between groups showed no statistical significance(P\u0026thinsp;=\u0026thinsp;0.124).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChanges of echocardiographic measurements and NYHA function class between LBBAP and RVP\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLBBAP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRVP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eANCOVA effect\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eLVEF(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e63.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e63.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-2.8(-5.0,-0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1-year follow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e63.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e60.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eLAD(mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e38.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e38.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.4(-1.0,1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.595\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1-year follow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e37.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eLVEDD(mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e48.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e49.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.3(0.1,2.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.036\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1-year follow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e47.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e49.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNYHA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.1(-0.1,0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.354\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1-year follow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003csup\u003e#\u003c/sup\u003eCompared with baseline status, P \u0026lt; 0.05. Values are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD.\u003c/p\u003e\u003cp\u003eAbbreviations as in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the present study, we prospectively examined the effect of LBBAP on cardiac function in patients with AVB with normal/impaired LVEF, and provided a comparison between LBBAP and RVP using propensity score matching analysis. Main findings of this study are: (1) LBBAP preserved or improved LVEF in AVB patients with normal/impaired LVEF; (2) LBBAP preserved LVEF and improved LVEDD compared with RVP.\u003c/p\u003e\u003cp\u003eConventional RVP could induce electrical and mechanical ventricular dyssynchrony, leading to decreased cardiac function and increased mortality, HFH and PICM[\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In recent years, BiVP has been proposed as an alternative to RVP in patients requiring high ventricular pacing rates. Three randomized trials have proved the superiority of BiVP over RVP in patients with moderate to severe systolic cardiac function[\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and BiVP is recommended in patients with AVB and LVEF\u0026thinsp;\u0026lt;\u0026thinsp;50% to reduce total mortality and HF[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. While, for patients with normal or preserved LVEF, data on benefit of BiVP are conflicting[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Because of higher costs and complications, clinical applications of BiVP have been limited. HBP could preserve ventricular synchrony[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and improve clinical outcomes in patients with preserved LVEF compared with RVP. Kronborg et al.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] found that HBP preserved LVEF and mechanical synchrony(55\u0026thinsp;\u0026plusmn;\u0026thinsp;10% vs 50\u0026thinsp;\u0026plusmn;\u0026thinsp;11%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) as compared with RVP in AVB patients with LVEF\u0026thinsp;\u0026gt;\u0026thinsp;40%. The study of Vijayaraman et al.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] showed similar results, the LVEF remained unchanged in the HBP group(55\u0026thinsp;\u0026plusmn;\u0026thinsp;8% vs 57\u0026thinsp;\u0026plusmn;\u0026thinsp;6%, P\u0026thinsp;=\u0026thinsp;0.13), whereas, significantly declined in the RVP group(57\u0026thinsp;\u0026plusmn;\u0026thinsp;7% vs 52\u0026thinsp;\u0026plusmn;\u0026thinsp;11%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and death or HFH was significantly lower in HBP group among patients with \u0026gt;\u0026thinsp;40% ventricular pacing percentage (32% vs 43%,HR1.9, P\u0026thinsp;=\u0026thinsp;0.04). Nevertheless, HBP has not become mainstream therapy clinically, because of technique challenges and higher pacing thresholds.\u003c/p\u003e\u003cp\u003eAs an alternative physiological pacing modality, LBBAP has been shown to preserve ventricular synchrony. Recent studies have demonstrated that the left ventricular synchrony of LBBAP is similar to that of native-conduction mode and superior to that of RVP[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Among AVB patients with LVEF\u0026thinsp;\u0026ge;\u0026thinsp;50%, Li et al.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] found that patients with LBBAP had stable LVEF (62.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6% vs 61.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4%, P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) and slightly decreased LVEDD (49.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6 vs 46.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2mm, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) compared with baseline at 1-year follow-up. The present study showed similar results, additionally, among patients with LVEF \u0026lt; 50%, LBBAP improved LVEF at 1-year follow-up. In the propensity score matching analysis, the comparison between LBBAP and RVP showed a significant difference in LVEF(P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and LVEDD(P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Compared with baseline, LBBAP improved NYHA functional class and NT-proBNP, whereas RVP did not showed similar effects, though changes between groups were not significantly different.\u003c/p\u003e\u003cp\u003ePICM is not uncommon in patients with permanent pacemakers. The incidence of PICM varied from 9\u0026ndash;26% depending on the definition of PICM and follow-up duration[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In this study, LBBAP showed a tendency to reduce PICM compared with RVP (0% vs 9.8%), though the difference was not significant. Given the small sample size of our study, clinical trials with larger sample size are needed to further evaluate the efficacy of LBBAP on PICM.\u003c/p\u003e\u003cp\u003eBoth BiVP and conduction system pacing are considered as physiological pacing modality. BiVP and HBP have been used for years in clinical practice, and showed beneficial effects on clinical outcomes. However, there are some defects, such as higher cost, lower procedure success rate, and increased capture threshold. Su et al.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] found that LBBAP succeeded in 618/632 (97.8%) patients, and with a 0.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24 mv capture threshold at 2-year follow-up. Meanwhile, LBBAP showed a risk of complications similar to that of RVP (3.5% vs 1.3; P\u0026thinsp;=\u0026thinsp;0.358) and significantly lower than did HBP (8.6% vs 1.3%; P\u0026thinsp;=\u0026thinsp;0.034).[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] LBBAP would become the mainstream pacing modality in clinical pacing modality.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Limitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis was a retrospective observational study in a single center, and the sample size was relatively small with only 8 patients having a baseline LVEF \u0026lt; 50%. LVEDD and LAD were compared between groups in the present study, while left ventricular volume and left atrial volume were not routinely measured. When comparing with the RVP group, we used propensity score matching to adjust for known confounders, however, there may be unknown and/or unmeasured confounders that affected. Future prospective randomized controlled trials with longer follow-up duration are needed.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eLBBAP might be a preferable pacing modality to improve cardiac remodeling and function in patients requiring high ventricular pacing burden compared with conventional RVP.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be constructed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki (as revised in 2o13) and approved by the Ethics Committee of the Affiliated People\u0026rsquo;s Hospital of Jiangsu University and the Institutional Review Board of the First Affiliated Hospital of Nanjing Medical University, and all patients gave written informed consent before participating in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTops LF, Schalij MJ, Bax JJ. The Effects of Right Ventricular Apical Pacing on Ventricular Function and Dyssynchrony. J Am Coll Cardiol. 2009;54(9):764\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKiehl EL, Makki T, Kumar R, Gumber D, Kwon DH, Rickard JW, Kanj M, Wazni OM, Saliba WI, Varma N, Wilkoff BL, Cantillon DJ. Incidence and predictors of right ventricular pacing-induced cardiomyopathy in patients with complete atrioventricular block and preserved left ventricular systolic function. HEART RHYTHM. 2016;13(12):2272\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, Lamas GA, Investigators MOST. 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. Circulation. 2003;107(23):2932\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTayal B, Fruelund P, Sogaard P, Riahi S, Polcwiartek C, Atwater BD, Gislason G, Risum N, Torp-Pedersen C, Kober L, Kragholm KH. Incidence of heart failure after pacemaker implantation: a nationwide Danish Registry-based follow-up study. Eur Heart J. 2019;40(44):3641\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUdo EO, van Hemel NM, Zuithoff NPA, Doevendans PA, Moons KGM. Risk of heart failure- and cardiac death gradually increases with more right ventricular pacing. INT J CARDIOL. 2015;185:95\u0026ndash;100.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbdelrahman M, Subzposh FA, Beer D, Durr B, Naperkowski A, Sun H, Oren JW, Dandamudi G, Vijayaraman P. Clinical Outcomes of His Bundle Pacing Compared to Right Ventricular Pacing. J Am Coll Cardiol. 2018;71(20):2319\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKronborg MB, Mortensen PT, Poulsen SH, Gerdes JC, Jensen HK, Nielsen JC. His or para-His pacing preserves left ventricular function in atrioventricular block: a double-blind, randomized, crossover study. EUROPACE. 2014;16(8):1189\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVijayaraman P, Naperkowski A, Subzposh FA, Abdelrahman M, Sharma PS, Oren JW, Dandamudi G, Ellenbogen KA. Permanent His-bundle pacing: Long-term lead performance and clinical outcomes. Heart Rhythm. 2018;15(5):696\u0026ndash;702.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHuang W, Su L, Wu S, Xu L, Xiao F, Zhou X, Ellenbogen KA. (2017) A Novel Pacing Strategy With Low and Stable Output: Pacing the Left Bundle Branch Immediately Beyond the Conduction Block. CAN J CARDIOL 33(12):1736.e1-1736.e3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHou X, Qian Z, Wang Y, Qiu Y, Chen X, Jiang H, Jiang Z, Wu H, Zhao Z, Zhou W, Zou J. Feasibility and cardiac synchrony of permanent left bundle branch pacing through the interventricular septum. Europace. 2019;21(11):1694\u0026ndash;702.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi X, Li H, Ma W, Ning X, Liang E, Pang K, Yao Y, Hua W, Zhang S, Fan X. Permanent left bundle branch area pacing for atrioventricular block: Feasibility, safety, and acute effect. HEART RHYTHM. 2019;16(12):1766\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi X, Zhang J, Qiu C, Wang Z, Li H, Pang K, Yao Y, Liu Z, Xie R, Chen Y, Wu Y, Fan X. Clinical Outcomes in Patients With Left Bundle Branch Area Pacing vs. Right Ventricular Pacing for Atrioventricular Block. Front Cardiovasc Med. 2021;8:685253.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHuang W, Chen X, Su L, Wu S, Xia X, Vijayaraman P. A beginner's guide to permanent left bundle branch pacing. Heart Rhythm. 2019;16(12):1791\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJiang H, Hou X, Qian Z, Wang Y, Tang L, Qiu Y, Jiang Z, Chen X, Li K, Zou J. A novel 9-partition method using fluoroscopic images for guiding left bundle branch pacing. HEART RHYTHM. 2020;17(10):1759\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCho SW, Gwag HB, Hwang JK, Chun KJ, Park KM, On YK, Kim JS, Park SJ. Clinical features, predictors, and long-term prognosis of pacing‐induced cardiomyopathy. Eur J Heart Fail. 2019;21(5):643\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCurtis AB, Worley SJ, Adamson PB, Chung ES, Niazi I, Sherfesee L, Shinn T, St M. (2013) Biventricular Pacing for Atrioventricular Block and Systolic Dysfunction. New Engl J Med 368(17):1585\u0026ndash;1593.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKindermann M, Hennen B, Jung J, Geisel J, B\u0026ouml;hm M, Fr\u0026ouml;hlig G. Biventricular versus conventional right ventricular stimulation for patients with standard pacing indication and left ventricular dysfunction -: The Homburg Biventricular Pacing Evaluation (HOBIPACE). J Am Coll Cardiol. 2006;47(10):1927\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMartinelli Filho M, De Siqueira SF, Costa R, Greco OT, Moreira LF, D'Avila A, Heist EK. Conventional Versus Biventricular Pacing in Heart Failure and Bradyarrhythmia: The COMBAT Study. J CARD FAIL. 2010;16(4):293\u0026ndash;300.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHeidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. Amer Coll C, Amer Heart Assoc Joint Comm C (2022) 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 79(17):e253-e421.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStockburger M, G\u0026oacute;mez-Doblas JJ, Lamas G, Alzueta J, Fern\u0026aacute;ndez‐Lozano I, Cobo E, Wiegand U, Concha JF, Navarro X, Navarro‐L\u0026oacute;pez F, de Teresa E. Preventing ventricular dysfunction in pacemaker patients without advanced heart failure: results from a multicentre international randomized trial (PREVENT‐HF). Eur J Heart Fail. 2011;13(6):633\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYu CM, Fang F, Luo XX, Zhang Q, Azlan H, Razali O. Long-term follow‐up results of the Pacing to Avoid Cardiac Enlargement (PACE) trial. Eur J Heart Fail. 2014;16(9):1016\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang J, Guo J, Hou X, Wang Y, Qian Z, Li K, Ge P, Zou J. Comparison of the effects of selective and non-selective His bundle pacing on cardiac electrical and mechanical synchrony. EUROPACE. 2018;20(6):1010\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCai B, Huang X, Li L, Guo J, Chen S, Meng F, Wang H, Lin B, Su M. Evaluation of cardiac synchrony in left bundle branch pacing: Insights from echocardiographic research. J Cardiovasc Electr. 2020;31(2):560\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCho SW, Bin Gwag H, Hwang JK, Chun KJ, Park K-M, On YK, Kim JS, Park S-J. Clinical features, predictors, and long-term prognosis of pacing-induced cardiomyopathy. EUR J HEART FAIL. 2019;21(5):643\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSu L, Wang S, Wu S, Xu L, Huang Z, Chen X, Zheng R, Jiang L, Ellenbogen KA, Whinnett ZI, Huang W. Long-Term Safety and Feasibility of Left Bundle Branch Pacing in a Large Single-Center Study. Circ- Arrhythm Electrophysiol. 2021;14(2):e009251.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePalmisano P, Ziacchi M, Dell\u0026rsquo;Era G, Donateo P, Ammendola E, Coluccia G, Guido A, Piemontese GP, Lazzeri M, Ghiglieno C, Veroli A, Maggi R, Russo V, Rago A, Nigro G, Senes J, Patti G, Biffi M, Accogli M. Rate and nature of complications of conduction system pacing compared with right ventricular pacing: Results of a propensity score\u0026ndash;matched analysis from a multicenter registry. Heart Rhythm. 2023;20(7):984\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"left bundle branch area pacing, right ventricular pacing, atrioventricular block, left ventricular ejection fraction, pacing induced cardiomyopathy","lastPublishedDoi":"10.21203/rs.3.rs-6695039/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6695039/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eConventional right ventricular pacing (RVP) causes cardiac dyssynchrony, and increases risk of pacing-induced cardiomyopathy (PICM), heart failure hospitalization and mortality. Left bundle branch area pacing (LBBAP) is a promising physiological pacing modality, we compared the effect of LBBAP on cardiac function with RVP in patients with atrioventricular block (AVB).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A total of 118 patients with AVB who successfully underwent LBBAP were enrolled between June 2019 and June 2022. Among them, 110 patients with a baseline LVEF≥50% were propensity-matched 1:1 with 49 patients who underwent RVP during the same period. Ultimately, 41 patients with well-matched baseline characteristics in both groups were included in the analysis. Echocardiographic parameters and NYHA classification at 1-year follow-up were compared between the groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eLeft ventricular ejection fraction (LVEF) remained stable in patients with LVEF≥50% (62.9±2.9 vs 62.9±3.3, P=0.960), and improved significantly in patients with LVEF\u0026lt;50% (58.0±9.9% vs 44.2±5.5%, P\u0026lt;0.05) at 1-year follow-up in the LBBAP group. Propensity score matching for baseline characteristics yielded 41 matched pairs. Changes in LVEF and left ventricular end-diastolic diameter (LVEDD) in the LBBAP group were significantly different from those in the RVP group: LVEF [-2.8(-5.0, -0.6), P=0.015] and LVEDD [1.3(0.1, 2.5), P=0.036], respectively. Compared with baseline, NYHA classification improved significantly in the LBBAP group (1.3 ±0.5 vs 1.0 ±0.2, P\u0026lt;0.05), while remained changed in the RVP group (1.3 ±0.4 vs 1.1 ±0.3, P=0.232). LBBAP showed a tendency to reduce PICM compared with RVP (0% vs 9.8%), though the difference was not significant (P=0.124).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e LBBAP might be a preferable pacing modality to improve cardiac remodeling and function in patients requiring high ventricular pacing burden compared with conventional RVP.\u003c/p\u003e","manuscriptTitle":"Effect of left bundle branch area pacing on cardiac remodeling and function: propensity score matching with right ventricular pacing","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-04 10:22:06","doi":"10.21203/rs.3.rs-6695039/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-19T10:31:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-18T22:19:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-05T03:53:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"90129945920800449159814283308092442061","date":"2025-07-31T12:32:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"137550541042439536394440375395672657109","date":"2025-07-30T10:34:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-30T10:17:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-30T09:27:08+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-28T09:04:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-26T03:06:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-07-26T03:03:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"244c5f7c-2c97-44d2-92d5-a1454686f0f2","owner":[],"postedDate":"August 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:10:48+00:00","versionOfRecord":{"articleIdentity":"rs-6695039","link":"https://doi.org/10.1186/s12872-025-05334-y","journal":{"identity":"bmc-cardiovascular-disorders","isVorOnly":false,"title":"BMC Cardiovascular Disorders"},"publishedOn":"2025-11-28 15:57:20","publishedOnDateReadable":"November 28th, 2025"},"versionCreatedAt":"2025-08-04 10:22:06","video":"","vorDoi":"10.1186/s12872-025-05334-y","vorDoiUrl":"https://doi.org/10.1186/s12872-025-05334-y","workflowStages":[]},"version":"v1","identity":"rs-6695039","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6695039","identity":"rs-6695039","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}