The Functional and Imaging Implications of Left Bundle Branch Pacing in Ischemic Cardiomyopathy
Heart failure with reduced ejection fraction due to ischemic cardiomyopathy remains a significant clinical challenge. Electrical conduction delays exacerbate symptoms by causing uncoordinated contractions, reducing pumping efficiency, and increasing mortality. Right ventricular pacing further worsen...
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MDPI AG
2025-03-01
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| author | Fulvio Cacciapuoti Ciro Mauro Ilaria Caso Salvatore Crispo Rossella Gottilla Valentina Capone Saverio Ambrosino Ciro Pirozzi Orlando Munciguerra Mario Volpicelli |
| author_facet | Fulvio Cacciapuoti Ciro Mauro Ilaria Caso Salvatore Crispo Rossella Gottilla Valentina Capone Saverio Ambrosino Ciro Pirozzi Orlando Munciguerra Mario Volpicelli |
| author_sort | Fulvio Cacciapuoti |
| collection | DOAJ |
| description | Heart failure with reduced ejection fraction due to ischemic cardiomyopathy remains a significant clinical challenge. Electrical conduction delays exacerbate symptoms by causing uncoordinated contractions, reducing pumping efficiency, and increasing mortality. Right ventricular pacing further worsens dyssynchrony, while resynchronization therapy improves outcomes but has a high non-responder rate. Given these limitations, bundle branch pacing engages the heart’s conduction system, restoring synchronized contraction and enhancing cardiac function. This review examines the impact of left-bundle-branch-block-induced dyssynchrony, the role of advanced imaging in assessing ventricular function, and the clinical outcomes of bundle branch pacing in heart failure patients. Specifically, we explore the mechanical and hemodynamic effects of left bundle branch block, imaging techniques for dyssynchrony evaluation, and the comparative benefits of bundle branch pacing versus resynchronization therapy. Conduction delays impair function, increase myocardial stress, and worsen clinical outcomes. Advanced imaging plays a critical role in patient selection, identifying those most likely to benefit from conduction system pacing. By restoring electrical coordination, bundle branch pacing enhances ventricular function, reduces hospitalizations, and promotes reverse remodeling. It offers similar or superior benefits to conventional resynchronization therapy, regulates stress hormones, reduces oxidative damage, and improves calcium handling. Bundle branch pacing represents a significant advancement in heart failure management, but careful patient selection remains crucial. Future research should focus on optimizing implantation techniques and validating long-term benefits through large-scale clinical trials. |
| format | Article |
| id | doaj-art-02848a5af0764e6399a3d4bee6ee22a7 |
| institution | DOAJ |
| issn | 2218-273X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomolecules |
| spelling | doaj-art-02848a5af0764e6399a3d4bee6ee22a72025-08-20T03:14:21ZengMDPI AGBiomolecules2218-273X2025-03-0115448910.3390/biom15040489The Functional and Imaging Implications of Left Bundle Branch Pacing in Ischemic CardiomyopathyFulvio Cacciapuoti0Ciro Mauro1Ilaria Caso2Salvatore Crispo3Rossella Gottilla4Valentina Capone5Saverio Ambrosino6Ciro Pirozzi7Orlando Munciguerra8Mario Volpicelli9Division of Cardiology, “A. Cardarelli” Hospital, 80131 Naples, ItalyDivision of Cardiology, “A. Cardarelli” Hospital, 80131 Naples, ItalyDepartment of Cardiology, “V. Monaldi” Hospital, 80131 Naples, ItalyDivision of Cardiology, “A. Cardarelli” Hospital, 80131 Naples, ItalyDivision of Cardiology, “A. Cardarelli” Hospital, 80131 Naples, ItalyDivision of Cardiology, “A. Cardarelli” Hospital, 80131 Naples, ItalyDepartment of Cardiology, “Santa Maria della Pietà” Hospital, 80035 Naples, ItalyDepartment of Cardiology, “Santa Maria della Pietà” Hospital, 80035 Naples, ItalyDepartment of Cardiology, “Santa Maria della Pietà” Hospital, 80035 Naples, ItalyDepartment of Cardiology, “Santa Maria della Pietà” Hospital, 80035 Naples, ItalyHeart failure with reduced ejection fraction due to ischemic cardiomyopathy remains a significant clinical challenge. Electrical conduction delays exacerbate symptoms by causing uncoordinated contractions, reducing pumping efficiency, and increasing mortality. Right ventricular pacing further worsens dyssynchrony, while resynchronization therapy improves outcomes but has a high non-responder rate. Given these limitations, bundle branch pacing engages the heart’s conduction system, restoring synchronized contraction and enhancing cardiac function. This review examines the impact of left-bundle-branch-block-induced dyssynchrony, the role of advanced imaging in assessing ventricular function, and the clinical outcomes of bundle branch pacing in heart failure patients. Specifically, we explore the mechanical and hemodynamic effects of left bundle branch block, imaging techniques for dyssynchrony evaluation, and the comparative benefits of bundle branch pacing versus resynchronization therapy. Conduction delays impair function, increase myocardial stress, and worsen clinical outcomes. Advanced imaging plays a critical role in patient selection, identifying those most likely to benefit from conduction system pacing. By restoring electrical coordination, bundle branch pacing enhances ventricular function, reduces hospitalizations, and promotes reverse remodeling. It offers similar or superior benefits to conventional resynchronization therapy, regulates stress hormones, reduces oxidative damage, and improves calcium handling. Bundle branch pacing represents a significant advancement in heart failure management, but careful patient selection remains crucial. Future research should focus on optimizing implantation techniques and validating long-term benefits through large-scale clinical trials.https://www.mdpi.com/2218-273X/15/4/489bundle branch pacing (BBP)heart failure with reduced ejection fraction (HFrEF)ischemic cardiomyopathycardiac resyncronization therapy (CRT) |
| spellingShingle | Fulvio Cacciapuoti Ciro Mauro Ilaria Caso Salvatore Crispo Rossella Gottilla Valentina Capone Saverio Ambrosino Ciro Pirozzi Orlando Munciguerra Mario Volpicelli The Functional and Imaging Implications of Left Bundle Branch Pacing in Ischemic Cardiomyopathy Biomolecules bundle branch pacing (BBP) heart failure with reduced ejection fraction (HFrEF) ischemic cardiomyopathy cardiac resyncronization therapy (CRT) |
| title | The Functional and Imaging Implications of Left Bundle Branch Pacing in Ischemic Cardiomyopathy |
| title_full | The Functional and Imaging Implications of Left Bundle Branch Pacing in Ischemic Cardiomyopathy |
| title_fullStr | The Functional and Imaging Implications of Left Bundle Branch Pacing in Ischemic Cardiomyopathy |
| title_full_unstemmed | The Functional and Imaging Implications of Left Bundle Branch Pacing in Ischemic Cardiomyopathy |
| title_short | The Functional and Imaging Implications of Left Bundle Branch Pacing in Ischemic Cardiomyopathy |
| title_sort | functional and imaging implications of left bundle branch pacing in ischemic cardiomyopathy |
| topic | bundle branch pacing (BBP) heart failure with reduced ejection fraction (HFrEF) ischemic cardiomyopathy cardiac resyncronization therapy (CRT) |
| url | https://www.mdpi.com/2218-273X/15/4/489 |
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