Comparing different activation patterns in a physiological pacing case: Insights from high-resolution mapping

Right ventricular (RV) pacing has been the mainstay of bradycardia therapy for several decades. However, the recognition of deleterious effects of RV pacing has led to the search for more physiologic forms of pacing. Physiological Pacing, including His bundle pacing (HBP) and left bundle branch pacing (LBBP), has recently been shown to have better synchronization of the left ventricle, and potentially reduces heart failure1,2. However, high-resolution ventricular activation patterns during different pacing modes have been seldom reported.