Capture Verification in Left Bundle Branch Area Pacing: Reporting Gaps and a Practical Framework
Athanasios Saplaouras, Panagiotis Mililis, Stavroula Koskina, Ourania Kariki, George Bazoukis, Paraskevas Tsaplaris, Athanasios Makris, Sokratis Oikonomou, Michael Efremidis, Konstantinos P. LetsasABSTRACT
Background
Left bundle branch area pacing (LBBAP) comprises two physiologically distinct interventions: left bundle branch pacing (LBBP), which captures the conduction system, and left ventricular septal pacing (LVSP), which captures septal myocardium only. How consistently studies document which was achieved is unknown.
Methods
We searched PubMed/MEDLINE, Europe PMC, and OpenAlex to June 21, 2026, and audited the eligible studies against ten prespecified reporting items, four primary and six supporting. Screening and extraction were independent and in duplicate. A continuous 0–100 score, threshold sensitivity analyses, and stratification were post hoc.
Results
An explicit capture definition was reported in 43 of 46 studies (93%), a numerator with denominator in 32 (70%), and outcomes by capture status in 18 (39%). LBBP, LVSP, and indeterminate capture were separated in one study (2%). Independent adjudication was described in two (4%), follow‐up reassessment in seven (15%), and programmed output in three (7%). No study reported all four primary items with at least four supporting items; the median score was 43.3. Across seven alternative thresholds, six studies (13%) qualified at most. Studies from 2024 to 2026 scored higher than those from 2020 to 2023 (median 55.0 vs. 36.7; p = 0.015), although reporting of adjudication did not improve and reporting of reassessment only marginally. These comparisons were exploratory and unadjusted for multiplicity.
Conclusions
In LBBAP studies with extractable capture information, capture verification is reported inconsistently and is often not separated from procedural success. We propose a reporting framework and an exploratory, author‐derived capture‐confidence score.