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Novel bradycardia pacing strategies
  1. Luuk Heckman1,
  2. Pugazhendhi Vijayaraman2,
  3. Justin Luermans3,4,
  4. Antonius M W Stipdonk3,
  5. Floor Salden3,
  6. Alexander H Maass5,
  7. Frits W Prinzen1,
  8. Kevin Vernooy3,4
  1. 1 Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands
  2. 2 Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes Barre, Pennsylvania, USA
  3. 3 Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
  4. 4 Department of Cardiology, Radboud University Medical Centre (Radboudumc), Nijmegen, The Netherlands
  5. 5 Department of Cardiology, University of Groningen, University Medical Centre Groningen (UMCG), The Netherlands
  1. Correspondence to Dr Kevin Vernooy, Cardiology, Maastricht University Medical Centre, Maastricht 6202 AZ, The Netherlands; kevin.vernooy{at}


The adverse effects of ventricular dyssynchrony induced by right ventricular (RV) pacing has led to alternative pacing strategies, such as biventricular, His bundle (HBP), LV septal (LVSP) and left bundle branch pacing (LBBP). Given the overlap, LVSP and LBBP are also collectively referred to as left bundle branch area pacing (LBBAP). Although among these alternative pacing sites HBP is theoretically the ideal strategy as it maintains a physiological ventricular activation, its application requires more skills and is associated with the most complications. LBBAP, where the ventricular pacing lead is advanced through the interventricular septum to its left side, creates ventricular activation that is only slightly more dyssynchronous. Preliminary studies have shown that LBBAP is feasible, safe and encounters less limitations than HBP. Further studies are needed to differentiate between LVSP and LBBP with regard to acute functional and long-term clinical outcome.

  • bradyarrhythmias
  • pacemakers

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  • Twitter @HeckmanLuuk, @kvernooy

  • Contributors All authors meet authorship criteria as stated in ICMJE Recommendations.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests PV: fellowship support and research grant from Medtronic; honorarium from Abbott, Biotronik, Boston Scientific and Medtronic. Patent pending for His delivery tool. FWP: research grants from Medtronic, Abbott, MicroPort CRM, Biotronik. KV: research grants from Medtronic, Abbott and Biotronik, consultancy agreement with Medtronic. AHM: lecture fees from Abbott. TvS: lecture fees from Abbott. JL: consultancy agreement Medtronic.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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