High burden right ventricular (RV) pacing has been shown to increase cardiovascular mortality, incidence of heart failure (HF), worsen left ventricular (LV) function and accelerate the development of atrial fibrillation (AF). High percentage ventricular pacing and wider paced QRS in the setting of normal baseline LV ejection fractions have consistently been shown to be independent risk factors for pacing-induced cardiomyopathy. Left bundle branch pacing (LBBP) has emerged as a potential alternative pacing mechanism that may avoid LV dyssynchrony and pacing-induced LV dysfunction by mimicking native electrical conduction.
Age ≥ 18 years
Patients with an ejection fraction of >35%
Third degree AV block
Symptomatic or asymptomatic second-degree AV block
Indication for an implantable cardioverter defibrillator
Presence of a mechanical tricuspid valve
Any prior attempt at implantation of an ICD, CRT, HBP, or LBBP
Lack of capacity to consent
McGill University Health Centre/Research Institute of the McGill University Health Centre
Lead sponsor
Heart and Stroke Foundation of Canada
Collaborator
Canadian Institutes of Health Research (CIHR)
Collaborator