Virginia Heart Cardiologists Lead the Way with an Innovative Technique to Mimic the Heart's Normal Electrical Activation

Virginia Heart patients with heart failure and a condition called left bundle branch block (LBBB) are benefiting from a new approach called left bundle branch area pacing to mimic the heart’s normal electrical activation. Our cardiologists are early adopters of this technique and are helping to train physicians nationwide on its use.

LBBB is a problem with the heart’s electrical wiring (conduction) system. In a healthy heart, the signal to start your heartbeat begins in the upper right chamber of the heart (right atrium). From there, the signal travels to the lower chambers (right and left ventricles), which squeeze blood out of the heart to the rest of the body. As the signal travels along the heart's conduction system, it rapidly and efficiently activates parts of the heart to contract in a coordinated manner.

Two bundle branches – the left and right – carry the electrical signal. In LBBB, the electrical signal travels slowly through the left ventricle, causing it to contract later than it should. When the normal electrical activation of your heartbeat is disrupted, we call this “ventricular dyssynchrony.” It can cause the heart to eject blood less efficiently. While LBBB can result from aging or a number of heart conditions, it is most often seen in patients with heart failure.

LBBB may not impact you if you are generally healthy with no underlying conditions. But if you are over 65 and have heart disease or another cardiovascular disorder, untreated LBBB can have a serious impact. Symptoms that indicate treatment is needed include shortness of breath, decreased exercise capacity and general fatigue. The symptoms can start off subtle and then become more prominent, like swelling in the legs.

Traditionally, this problem has been treated with cardiac resynchronization therapy (CRT), using an implanted pacemaker with extra leads to stimulate the left ventricle from multiple locations so that they pump in a coordinated fashion. Even though there is a lot of data behind this procedure, it is not a perfect solution as some patients fail to improve  or multiple wires cannot be successfully placed due to anatomic challenges.

A fairly recent alternative to CRT for patients with LBBB is left bundle branch area pacing, where we activate the conduction system of the heart with a single lead by stimulating and tapping into the left bundle branch. While long-term data is still forthcoming, the technique already looks very promising.

Left bundle branch area pacing is similar to a standard pacemaker implant, but in this case the pacemaker lead is inserted near the left bundle branch, which ensures that pacing closely mimics the heart’s normal contractions, allowing the left ventricle to activate rapidly and efficiently. While this lead, manufactured by Medtronic,  has been used for many years, it recently received FDA approval for this specific application.

Our Virginia Heart electrophysiologists believe that this new technique should be considered  in all patients receiving a pacemaker. Following the procedure, our patients experience an improvement in their symptoms and, compared to standard pacemaker implantation, there is less risk of some pacemaker-induced complications such as cardiomyopathy (a disease of the heart muscle that impacts the heart’s ability to pump blood effectively).

The Virginia Heart team was the first in Northern Virginia to use this promising technique and we are one of the highest volume users of left bundle branch area pacing in the country. In addition to improving outcomes for our own patients, our goal is to raise awareness and help train other electrophysiologists. We believe that our colleagues should consider this in every patient considered for pacemaker implantation so we can have better outcomes for everyone.

The Heart Rhythm Center at Virginia Heart is comprised of 6 electrophysiologists who manage and treat the entire spectrum of ablative and device-based heart rhythm disorders in addition to stroke prevention. For questions, please call 703-621-4501 to make an appointment.