Left bundle branch area pacing in patients with and without interventricular septal hypertrophy: a systemic review and meta-analysis.

BACKGROUND

Conduction disease is common in patients with interventricular septal hypertrophy (IVSH). Left bundle branch area pacing (LBBAP) is a physiological pacing approach which preserves interventricular synchrony. There is limited data regarding the success rate and outcomes of LBBAP in patients with IVSH. In this study, we aimed to synthesize all available evidence on the feasibility and outcomes of LBBAP in patients with IVSH compared to those without IVSH.

METHODS

We systematically reviewed bibliographic databases to identify studies published through August 2025. We included observational studies with available quantitative information on the success rate of LBBAP, lead penetration depth, paced QRS duration, and left ventricle activation time (LVAT) in patients with versus without IVSH. Estimates were combined using random-effects meta-analysis models and reported as risk ratios (RR) and 95% confidence intervals (CI).

RESULTS

Three studies were included in the quantitative synthesis (49 IVSH and 701 non-IVSH patients). The pooled RR for success rate of LBBAP in IVSH patients compared to non-IVSH controls was 0.92 (95% CI = 0.82-1.04; P = 0.20). The pooled mean difference for lead penetration depth in IVSH patients compared to non-IVSH controls was 4.84 mm (95% CI = 3.86-5.82; P < 0.00001). The pooled mean difference for paced QRS duration in IVSH patients compared to non-IVSH controls was 6.66 ms (95% CI = 1.94 - 11.39; P = 0.006). The pooled mean difference for LVAT in IVSH patients compared to non-IVSH controls was 6.37 ms (95% CI = 3.07-9.67; P = 0.0002).

CONCLUSIONS

Compared to non-IVSH patients, those with IVSH had comparable success rate of LBBAP with greater lead penetration depth, wider QRS duration, and longer LVAT.