Conduction system pacing may prevent the decline in septal myocardial work seen with standard pacing. Findings were presented at the European Society of Cardiology Congress 2025.

Patients suffering from atrioventricular block received either conduction system pacing or right ventricular pacing. Eighteen age- and sex-matched participants (nine per group) were followed for a median of 27 weeks. Echocardiography-derived myocardial work measurements were used to track changes in septal and lateral ventricular function over time.

Septal work index remained stable in patients receiving conduction system pacing, from 1458±615 to 1520±586 mmHg%. In contrast, septal work decreased in right ventricular pacing patients, from 1645±498 to 925±392 mmHg%. The difference between groups was statistically significant (p=0.03). Lateral work index increased in both groups over the follow-up period, with no significant difference observed (p=0.75).

These findings suggest that conduction system pacing better preserves septal myocardial function compared to right ventricular pacing. Myocardial work analysis can detect early changes in left ventricular mechanics and may provide insight into the mechanistic advantages of emerging bradycardia pacing strategies.