Defining left bundle branch block patterns in cardiac resynchronisation therapy: A return to his bundle recordings

Roderick Tung, Gaurav A. Upadhyay

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Left bundle branch block (LBBB) is associated with improved outcome after cardiac resynchronisation therapy (CRT). One historical presumption of LBBB has been that the underlying pathophysiology involved diffuse disease throughout the distal conduction system. The ability to normalize wide QRS patterns with His bundle pacing (HBP) has called this notion into question. The determination of LBBB pattern is conventionally made by assessment of surface 12-lead ECGs and can include patients with and without conduction block, as assessed by invasive electrophysiology study (EPS). During a novel extension of the classical EPS to involve left-sided recordings, we found that conduction block associated with the LBBB pattern is most often proximal, usually within the left-sided His fibres, and these patients are the most likely to demonstrate QRS correction with HBP for resynchronisation. Patients with intact Purkinje activation and intraventricular conduction delay are less likely to benefit from HBP. Future EPS are required to determine the impact of newer approaches to conduction system pacing, including intraseptal or left ventricular septal pacing. Left-sided EPS has the potential to refine patient selection in CRT trials and may be used to physiologically phenotype distinct conduction patterns beyond LBBB pattern.

Original languageEnglish (US)
Pages (from-to)28-33
Number of pages6
JournalArrhythmia and Electrophysiology Review
Issue number1
StatePublished - Mar 2020
Externally publishedYes


  • Biventricular pacing
  • Cardiac resynchronisation therapy
  • Conduction block
  • Electrophysiology
  • His bundle
  • Left bundle branch block
  • Septal activation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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