Luis Miguel Ruiz Velasquez

[Dr. José Ángel Cabrera @jacabreracardio]

Recognizing the septopulmonary region not as an isolated “bundle,” but as a functional 3D myocardial architecture, is essential for interpreting mapping data & optimizing ablation strategies
@JACCJournals @DrRoderickTung @davidgzcasal @DamianSanc1955

https://t.co/nnirFWiTnc

[Luis Miguel Ruiz Velasquez @Elelectrofisio]

@JICE_EP @adribaran @DrRoderickTung @Hapa_EP @ivroca @andresenriqueza @Margaridapujol @S_vazquez_calvo @jczerpa @DrFerminGarcia

[Luis Miguel Ruiz Velasquez @Elelectrofisio]

🚨 New publication in cardiac electrophysiology
Is LBBP truly superior to LVSP in CRT?

We conducted a systematic review & meta-analysis comparing both strategies in patients with heart failure.

Here’s what we found 👇

[Luis Miguel Ruiz Velasquez @Elelectrofisio]

📄 Full paper here: Journal of Interventional Cardiac Electrophysiology
https://t.co/Mgj5Zke01K

@JICE_EP @adribaran @DrRoderickTung @Hapa_EP @ivroca @andresenriqueza

#Cardiology #Electrophysiology #CRT #LBBP #HeartFailure #EPeeps

[Luis Miguel Ruiz Velasquez @Elelectrofisio]

🔮 What’s next?

We need:

✔ Randomized trials
✔ Standardized definitions
✔ Longer follow-up

[Luis Miguel Ruiz Velasquez @Elelectrofisio]

📌 Take-home message:

LBBP ≠ LVSP

👉 Conduction system capture matters
👉 Physiological pacing translates into clinical benefit

[Luis Miguel Ruiz Velasquez @Elelectrofisio]

📉 Heterogeneity?

Yes—but:

✔ Driven by individual studies
✔ Effect direction consistent
✔ Sensitivity analyses robust

👉 Signal remains stable

[Luis Miguel Ruiz Velasquez @Elelectrofisio]

⏱ Procedural aspects:

✔ No increase in procedure time
✔ Similar complication rates

⚠️ But:

➡ Slightly higher risk of septal perforation
(technique-dependent, mitigable)

[Luis Miguel Ruiz Velasquez @Elelectrofisio]

🧠 Mechanistic insight:

Unlike LVSP, LBBP captures the conduction system →
➡ Faster LV activation
➡ Improved electromechanical coupling
➡ Reverse remodeling

[Luis Miguel Ruiz Velasquez @Elelectrofisio]

⚡ Electrical performance matters:

LBBP achieved:

✔ Shorter paced QRS
✔ Better ventricular synchrony
✔ Greater improvement in LVEF

→ More physiological activation

[Luis Miguel Ruiz Velasquez @Elelectrofisio]

⚠️ However:

📉 No difference in all-cause mortality
HR 0.34 (p = 0.16)

Likely explained by:

⏳ Short follow-up
(as seen even in major CRT trials)

[Luis Miguel Ruiz Velasquez @Elelectrofisio]

🔥 MAIN FINDING

LBBP was associated with:

➡️ 73% reduction in HF-related hospitalization
HR 0.27 (95% CI 0.11–0.70)

This is a large and clinically meaningful effect.