What is a key feature of Selective (S-LBBAP) pacing?

Selective left bundle branch area pacing (S-LBBAP) is characterized by its ability to capture the left bundle branch (LBB) without simultaneously stimulating the adjacent local myocardium. This selectivity is crucial as it allows for a more physiological activation of the left ventricle, promoting synchronized contraction and improving cardiac function compared to conventional pacing methods.

The primary advantage of S-LBBAP lies in its focus on activating the conduction system directly, which leads to a more efficient contraction pattern. By only capturing the LBB, it facilitates conduction through the distal conduction system and allows the natural electrical activation pathway to be predominantly used, minimizing the risk of unwanted myocardial capture and associated adverse effects, such as inefficiencies in contraction or desynchronization between heart chambers.

This precise pacing minimizes the likelihood of potential pacing-induced cardiomyopathy, a concern with other pacing methodologies that inadvertently capture surrounding myocardial tissue along with the conduction system. Thus, the ability of S-LBBAP to selectively activate the LBB while avoiding local myocardial capture is foundational to its intended therapeutic benefits.