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Review
. 2025 Apr 22:58:101683.
doi: 10.1016/j.ijcha.2025.101683. eCollection 2025 Jun.

Myocardial work parameters in left bundle branch area pacing versus other pacing techniques: a systematic review and aggregate comparative analysis

Raffaella Mistrulli  1   2 , Sara Gharehdaghi  2   3   4 , Arthur Iturriagagoitia  2 , Elayne Kelen de Oliveira  2   5 , Lucio Addeo  2   5 , Stefano Valcher  2   6 , Sara Corradetti  1   2 , Michele Mattia Viscusi  2   5 , Peter Peytchev  2 , Ward A Heggermont  2 , Marc Vanderheyden  2 , Emanuele Barbato  1 , Guy Van Camp  2 , Martin Penicka  2
Affiliations
Review

Myocardial work parameters in left bundle branch area pacing versus other pacing techniques: a systematic review and aggregate comparative analysis

Raffaella Mistrulli et al. Int J Cardiol Heart Vasc. .

Abstract

Cardiac conduction disease often necessitates permanent pacemaker implantation. While right ventricular pacing (RVP) effectively treats bradycardia, it may lead to adverse cardiac remodeling and heart failure. Left bundle branch area pacing (LBBAP) has emerged as an alternative, potentially preserving myocardial function. Non-invasive myocardial work (MW) assessment provides valuable insights into left ventricular systolic function, energetics, and efficiency. This study systematically reviewed and analyzed MW parameters, comparing LBBAP to RVP and His bundle pacing (HBP). A meta-analysis of 241 patients across five studies examined four MW parameters-Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), and Global Work Efficiency (GWE)-at baseline, post-implantation, and last follow-up (median: 180 days, IQR: 7-360 days). At baseline, MW parameters were similar between LBBAP and RVP. Post-implantation, LBBAP preserved MW more effectively, showing significantly higher GWI than RVP (2250.0 ± 400.0 vs. 1600.0 ± 300.0 mmHg%, p = 0.027), a difference that remained significant at follow-up (p = 0.035). GWE was also significantly higher at follow-up (p = 0.011), while GCW and GWW showed no significant differences. MW parameters did not differ significantly between LBBAP and HBP (all p-values >0.05). These findings suggest that LBBAP provides superior MW preservation compared to RVP, with significant benefits in GWI and GWE, while demonstrating comparable performance to HBP.

Keywords: Cardiac pacing; His bundle pacing; Left bundle branch pacing; Myocardial work; Right ventricular pacing; Systematic review.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

None
Graphical abstract
Fig. 1
Fig. 1
Workflow for myocardial work assessment, integrating key measurements: (1) Blood pressure recording during echocardiography, ensuring positional consistency for accurate SBP estimation. (2) Acquisition of three standard transthoracic apical views with optimal frame rate. (3) Strain analysis with GLS and valve timing assessment. (4) Calculation of myocardial work indices, visualization of bull’s-eye plots, and PSL generation for functional evaluation.
Fig. 2
Fig. 2
PRISMA flow-chart.
Fig. 3
Fig. 3
Comparison of myocardial work parameters (GWI, GWE, GCW, and GWW) between LBBAP and RVP across Baseline, Post-Implantation, and Last Follow-Up. Box plots show data distribution, with notches indicating confidence intervals and p-values denoting statistical differences. Error bars represent standard deviation.
Fig. 4
Fig. 4
Comparison of Global Work Index (GWI) between LBBAP (red) and HBP (black) at baseline and post-implantation. Box plots display data distribution, with notches indicating confidence intervals. The p-values denote statistical comparisons, and error bars represent standard deviation for each phase. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
See this image and copyright information in PMC

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