Pacing and clinical electrophysiology : PACE最新文献

{"title":"Atrial Flutter in Partially Anomalous Pulmonary Venous Return: Electrophysiological Insights in Holt-Oram Syndrome.","authors":"Marinos Kosmopoulos, Babken Asatryan, Andreas Barth, Ashish Doshi, Zachariah Hale, Ari Cedars, Konstantinos N Aronis","doi":"10.1111/pace.70442","DOIUrl":"https://doi.org/10.1111/pace.70442","url":null,"abstract":"<p><p>Partially anomalous pulmonary vein return (PAPVR) is a heterogeneous group of congenital heart defects. Here, we describe a 51-year-old patient with corrected PAPVR (cPAPVR) and atrioventricular canal defect who presented for AFL ablation. The right pulmonary veins were isolated, and the OP was heterogeneously fibrotic. Three left AFL and one cavo-tricuspid isthmus (CTI)-dependent AFL were induced and mapped using activation and Ablation at each site terminated the AFL. Subsequently, the entire OP was isolated. Post-ablation, she had no atrial arrhythmia at 6 months follow up. Genetic testing identified a pathological mutation in the TBX5 gene, consistent with Holt-Oram syndrome.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late-Onset Atrioventricular Block and Significant Conduction Disturbances After Cardiac Interventions in Children.","authors":"Ayse Sulu, Osman Baspinar, Derya Aydin Sahin","doi":"10.1111/pace.70449","DOIUrl":"https://doi.org/10.1111/pace.70449","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Late-onset postoperative atrioventricular (AV) block is a rare condition with a reported incidence ranging between 0.3% and 0.7%, and it may be associated with high mortality rates (28%-100%). The aim of this study was to evaluate the clinical characteristics of pediatric patients who developed late AV block at our center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this retrospective case series, pediatric patients evaluated for permanent pacemaker implantation during the study period were retrospectively reviewed. Patients who developed late-onset (&gt;1 month) atrioventricular block or another clinically significant conduction disturbance requiring consideration of permanent pacing following surgical, transcatheter, or electrophysiological cardiac interventions between 2007 and 2025 were included. Patients with early postoperative block (&lt;1 month), congenital AV block, congenitally corrected transposition of the great arteries (CCTGA), or atrial isomerism were excluded. Demographic data, underlying congenital heart disease, type and timing of the prior intervention, symptoms at presentation, pre-block rhythm data when available, electrocardiographic and Holter findings, heart rate, type of block, temporary pacing requirement, pacemaker implantation status, and follow-up outcomes were collected from electronic medical records.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 14 patients were included. The median age was 4.75 years (interquartile range [IQR]: 2.33-8.75)the mean body weight was 20.7 ± 16.8 kg. Seven patients were male. The mean age at the initial cardiac intervention was 2.17 ± 3.40 years (range: 0-12). The median interval between the index cardiac intervention and development of late conduction disease was 3.0 years (IQR: 1.75-4.62). At presentation, six patients were asymptomatic, three presented with syncope, four with signs of heart failure, and one was referred after resuscitated cardiac arrest. The index intervention was cardiac surgery in 10 patients, transcatheter structural intervention in three, and repeated AVNRT ablation in one. Nine patients had persistent complete AV block, four had intermittent complete AV block, and one had left bundle branch block with clinicallysignificantventricular pauses. Three patients had Down syndrome. Permanent pacemakers were implanted in 12 patients; one patient died after cardiac arrest, and one patient did not undergo implantation because of parental refusal. At the most recent available device interrogation, most implanted patients had a high ventricular pacing burden, generally ranging from approximately 72% to 100%, whereas two patients had low ventricular pacing burdens of approximately 1%-2% and 0.7%-2.5%, respectively CONCLUSION: Late-onset postoperative AV block is a rare but potentially fatal condition that may occur even years after cardiac interventions. Although it is most commonly observed after surgeries involving regions close to the AV node, such as atri","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leadless Pacemaker Use Following Transcatheter Aortic Valve Replacement: National Trends and Predictors, 2019-2023.","authors":"Serena Zhang, Rishab Agarwal, Justin Song, Emily D Yamron, Vikyath Satish, Samuel J Apple, John D Fisher, Kevin J Ferrick","doi":"10.1111/pace.70448","DOIUrl":"https://doi.org/10.1111/pace.70448","url":null,"abstract":"<p><strong>Background: </strong>New-onset conduction abnormalities requiring permanent pacemaker implantation are common following transcatheter aortic valve replacement (TAVR). Leadless pacemakers may reduce procedure-related complications in this high-risk population, however, national adoption and predictors of use remain poorly characterized. The objective of this study was to identify predictors and patterns of leadless versus conventional transvenous pacemaker implantation following TAVR in a nationally representative cohort.</p><p><strong>Methods: </strong>Using the 2019-2023 National Inpatient Sample, we identified TAVR hospitalizations with same-admission pacemaker implantation. Survey-weighted logistic regression evaluated predictors of leadless versus transvenous device selection, adjusting for demographics, payer, income, comorbidity burden, hospital characteristics, and procedure year.</p><p><strong>Results: </strong>Among 427,080 weighted TAVR hospitalizations, 28,580 (6.7%) included pacemaker implantation, with 3255 (11.4%) receiving a leadless device. Leadless use rose from 6.1% of pacemaker implants in 2019 to 14.3% in 2021, followed by stabilization through 2023. Temporal trends were the strongest independent predictor of leadless implantation (2021 vs. 2019: aOR 2.66 [95% CI 1.87-3.77]; p < 0.001). Higher comorbidity burden independently increased likelihood of leadless use (aOR 1.10 per 5-point Elixhauser increase; p < 0.001). Large hospitals (by bed size) were associated with higher odds of leadless implantation versus small hospitals (aOR 1.58 [1.13-2.21]; p = 0.007). Age, sex, payer, and income were not associated with device type.</p><p><strong>Conclusion: </strong>Leadless pacemaker adoption after TAVR increased substantially through 2021 and subsequently stabilized, with real-world usage associated with temporal trends, comorbidity burden, and institutional volume rather than patient demographics or socioeconomic factors. This suggests relatively equitable patient-level but institutionally uneven uptake of this emerging technology.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Should an Embolized Atrial Leadless Pacemaker Be Retrieved From the Pulmonary Artery?","authors":"Tomoki Fukui, Hajime Saeki, Miwa Miyoshi, Nobuyuki Ogasawara","doi":"10.1111/pace.70447","DOIUrl":"https://doi.org/10.1111/pace.70447","url":null,"abstract":"","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Loss of Septal Q Waves Is Associated With QRS Widening After Transcatheter Aortic Valve Implantation.","authors":"Samah AlKharji, Krishna Kumar, Abdullah Esmaeil, Ahmed AlShatti","doi":"10.1111/pace.70450","DOIUrl":"https://doi.org/10.1111/pace.70450","url":null,"abstract":"<p><strong>Background: </strong>Conduction disturbances remain a common complication following transcatheter aortic valve implantation (TAVI). While baseline conduction abnormalities are well-established predictors of post-procedural conduction disease or permanent pacemaker implantation, risk stratification in patients without baseline PR or QRS prolongation remains limited. Loss of septal Q waves (LSQ) may reflect underlying conduction system vulnerability but has not been systematically evaluated in this setting.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of consecutive patients undergoing TAVI at a single tertiary center between 2018 and 2024. Patients without baseline PR or QRS prolongation were included. LSQ was defined as the absence of Q waves in leads I, V5, and V6. The primary outcome was an increase in QRS duration  ≥ 20 ms.</p><p><strong>Results: </strong>Among 87 patients without baseline PR or QRS prolongation, 86 were evaluable for the primary outcome and QRS widening ≥20 ms occurred in 31 patients (36.0%). LSQ was present in 40.2% of patients. LSQ was associated with increased odds of QRS widening in unadjusted analysis (OR 2.71, 95% CI 1.09-6.74; p = 0.031). The association remained significant after adjustment for AF (adjusted OR 2.76, 95% CI 1.07-7.11; p = 0.035) (Table 2). AF was also independently associated with QRS widening (adjusted OR 3.79, 95% CI 1.10-13.08; p = 0.035).</p><p><strong>Conclusion: </strong>LSQ on pre-procedural ECG was independently associated with post-procedural QRS widening in patients undergoing TAVI without baseline PR or QRS prolongation. LSQ may serve as a simple, non-invasive marker of conduction system vulnerability with potential utility in risk stratification and post-procedural monitoring. These findings are hypothesis generating and warrant validation in larger prospective cohorts.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epicardial Use of Medtronic 3830 Lead in Pediatric Cardiac Resynchronization Therapy with Elevated Thresholds.","authors":"Husnu Firat Altin, Qusi Shaban, Ahmed Reyaz Lone, Shadab Wani, Olivier Ghez, Volkan Tuzcu","doi":"10.1111/pace.70349","DOIUrl":"https://doi.org/10.1111/pace.70349","url":null,"abstract":"<p><strong>Background: </strong>Epicardial pacing is standard in children, but conventional leads often fail due to high thresholds, fractures, or poor sensing after multiple surgeries.</p><p><strong>Case: </strong>A 10-year-old with restrictive cardiomyopathy and prior mitral valve replacement presented with loss of capture from fractured epicardial leads. Redo sternotomy attempts with conventional leads produced thresholds up to 8.0 V. A Medtronic SelectSecure 3830 lead was implanted epicardially, achieving improved thresholds (2.7 V → 1.1 V) and stable cardiac resynchronization therapy (CRT) pacemaker function. At 2 months, thresholds and impedances remained low and stable.</p><p><strong>Conclusion: </strong>Epicardial Medtronic SelectSecure 3830 lead implantation may be a feasible alternative in complex pediatric redo cases.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed Right Atrial Lead Perforation: Discrepancy Between Preoperative Findings and Surgical Inspection.","authors":"Noriyuki Kobayashi, Yasuharu Matsunaga-Lee, Yasuyuki Egami, Taichi Mukai, Ayako Sugino, Masaru Abe, Hiroaki Nohara, Syodai Kawanami, Naotaka Okamoto, Masamichi Yano, Masami Nishino","doi":"10.1111/pace.70440","DOIUrl":"https://doi.org/10.1111/pace.70440","url":null,"abstract":"<p><p>An 87-year-old man presented with chest pain and pericardial effusion two years after dual-chamber implantable cardioverter-defibrillator implantation. Computed tomography suggested delayed right atrial lead perforation, although the pacing threshold was initially unchanged. Five days later, the threshold increased from 0.875 to 2.0 V/0.4 ms, raising concern for progression of the perforation. However, surgical exploration revealed hemorrhagic pericardial effusion without active bleeding and only minimal protrusion of the screw tip. The right atrial wall was reinforced with felt and sutured without lead extraction or repositioning. The pacing threshold subsequently returned to baseline, and no further lead intervention was required.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Bundle Branch Area Pacing Versus Biventricular Pacing for Cardiac Resynchronization Therapy: A Meta-Analysis of RCTs.","authors":"Hassaan Imtiaz, Anthony Costa, Adil Sarvar Mohammed, Fayaz Hakim, Rachita Kour, Breeha Saeed, Khalil Kanjwal","doi":"10.1111/pace.70444","DOIUrl":"https://doi.org/10.1111/pace.70444","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Left bundle branch area pacing (LBBAP) has emerged as an alternative to conventional biventricular pacing (BiVP) for cardiac resynchronization therapy (CRT). While observational studies have suggested potential advantages of LBBAP in some domains. However, recent randomized controlled trials (RCTs) have reported conflicting results, and contemporary evidence has not been yet synthesized.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the efficacy and safety of LBBAP/conduction system pacing (CSP) versus conventional BiVP for CRT using currently available randomized controlled trial data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review and meta-analysis was performed in accordance with PRISMA guidelines. PubMed, Cochrane Library, Google Scholar, and major cardiovascular conference proceedings were searched from January 2016 through May 2026. Randomized controlled trials comparing LBBAP/CSP with BiVP in patients undergoing CRT were included. The primary outcome was all-cause mortality. Secondary outcomes included heart failure hospitalization, change in left ventricular ejection fraction (LVEF), QRS duration, clinical/echocardiographic response, pacing capture threshold, and procedural complications. Random-effects models with restricted maximum likelihood estimation and Hartung-Knapp adjustment were used.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Six fully published randomized trials comprising 792 patients (401 assigned to LBBAP/CSP and 391 to BiVP) were included in the primary analysis. All-cause mortality was similar between strategies (RR 0.56, 95% CI 0.12-2.72; p = 0.37; I&lt;sup&gt;2&lt;/sup&gt; = 51%). Likewise, no significant differences were observed in heart failure hospitalization (RR 0.67, 95% CI 0.24-1.89; p = 0.34), clinical/echocardiographic response (RR 0.99, 95% CI 0.89-1.11; p = 0.87), or change in LVEF (MD 0.54%, 95% CI -3.61 to 4.69; p = 0.75). LBBAP/CSP was associated with significantly narrower paced QRS duration (MD -7.88 ms, 95% CI -14.89 to -0.88; p = 0.03) and lower pacing capture thresholds (MD -0.38 V, 95% CI -0.67 to -0.09; p = 0.02). Procedural complication rates were comparable between groups (RR 0.97, 95% CI 0.64-1.48; p = 0.87). Subgroup analysis demonstrated a significant improvement in LVEF among trials employing a pure left bundle branch pacing protocol (MD 5.57%, 95% CI 4.86-6.28), whereas mixed CSP strategies showed no significant advantage (P &lt; 0.0001 for interaction).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;LBBAP/CSP provides superior electrical resynchronization characterized by narrower paced QRS duration and lower capture thresholds while maintaining a safety profile comparable to conventional BiVP. However, these mechanistic advantages did not translate into significant improvements in mortality, heart failure hospitalization, CRT response, or overall LVEF in currently available randomized trials. Larger adequately powered studies are needed to determine whether the physiological benefits of LBBA","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Low-Voltage Zones in Patients With Heart Failure With Preserved Ejection Fraction.","authors":"Shuntaro Tamura, Yosuke Nakatani, Jin Soga, Ryutaro Iwai, Hiroshi Hasegawa, Masato Sano, Tadashi Nakajima, Yoshiaki Kaneko, Hideki Ishii","doi":"10.1111/pace.70415","DOIUrl":"https://doi.org/10.1111/pace.70415","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) frequently coexists with heart failure with preserved ejection fraction (HFpEF), and low-voltage zones (LVZs) in the atria represent atrial remodeling. However, the impact of HFpEF on the extent and distribution of LVZs and ablation outcomes remains unknown.</p><p><strong>Objective: </strong>To characterize LVZs in patients with HFpEF undergoing AF ablation and evaluate their association with arrhythmia recurrence.</p><p><strong>Methods: </strong>A total of 128 consecutive patients (66±12 years) who underwent AF ablation for the first time were retrospectively analyzed. HFpEF was defined as a left ventricular ejection fraction >50% with a history of heart failure treatment or an HFA-PEFF score ≥5. Meanwhile, LVZs were defined as bipolar voltage <0.5 mV and quantified across five left atrial regions.</p><p><strong>Results: </strong>Forty-seven patients (36.7%) were diagnosed with HFpEF. LVZs were significantly more extensive in the overall left atrium in the HFpEF group (16.3±13.5 vs. 8.2±7.6 cm², p < 0.001), with the greatest difference being observed in the anterior wall (5.6±5.4 vs. 2.3±2.8 cm², p < 0.001). During 9±4 months, arrhythmia recurrence rates did not differ significantly between HFpEF and non-HFpEF groups (12.8% vs. 13.6%, p = 0.310). Posterior wall isolation was more frequently performed in the HFpEF group (27.6% vs. 4.9%, p < 0.001). In multivariable analysis, HFpEF, age, and persistent AF were independent determinants of LVZ extent.</p><p><strong>Conclusions: </strong>AF patients with HFpEF exhibit more extensive LVZs, indicating advanced atrial remodeling. Despite differences in atrial substrate and ablation strategy, arrhythmia recurrence rates were comparable between patients with and without HFpEF.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailoring the Atrioventricular Interval During Left Bundle Branch Pacing: Playing With Fusion.","authors":"Margarida Pujol-Lopez, Mariona Regany-Closa, Eduard Guasch, Paz Garre, Mireia Niebla, Esther Carro, Rebeca Domingo, Ivo Roca-Luque, José M Tolosana, Lluís Mont","doi":"10.1111/pace.70413","DOIUrl":"https://doi.org/10.1111/pace.70413","url":null,"abstract":"<p><strong>Background: </strong>Optimization of biventricular pacing for cardiac resynchronization therapy (CRT) with fusion (fusion-optimized intervals method) has been shown to improve left ventricular remodeling. However, information on programming the atrioventricular (AV) interval during left bundle branch pacing (LBBP) is scarce.</p><p><strong>Objective: </strong>Assess with electrocardiographic imaging (ECGI) the electrical benefit of optimization of the AV interval during LBBP.</p><p><strong>Methods: </strong>Retrospective analysis of prospectively collected data. Pilot study including patients who received LBBP with CRT indication, normal AV conduction, sinus rhythm, and left bundle branch block. ECGI was used to obtain non-invasive activation maps, ventricular activation times, and QRS widths during the optimization of the AV interval.</p><p><strong>Results: </strong>A total of 10 patients who received LBBP were included. Median age was 62 years (57-74 years), 40% were women, 20% had ischemic cardiomyopathy, and baseline LVEF was 29% (23%-36%). The baseline median QRS duration was 178 ms (168-187 ms), with a left ventricular activation time (LVAT) of 99 ms (90-109 ms), a right ventricular activation time (RVAT) of 42 ms (34-71 ms), and a total ventricular activation time (TAT) of 111 ms (105-131 ms). A non-tailored AV programming showed a QRS measured from intrinsic deflection of 142 ms (137-149 ms); when a tailored AV was programmed, the median QRS decreased to 124 ms (116-130 ms). Ventricular activation times showed shortening with a tailored approach.</p><p><strong>Conclusion: </strong>AV interval adjustment during left bundle branch pacing may result in better resynchronization.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}