Zhang W, Huang J, Qi Y, et al. - Among consecutive heart failure (HF) patients (n = 11) with reduced left ventricular ejection fraction (LVEF) and left bundle branch block (LBBB) with an indication for cardiac resynchronization therapy (CRT), researchers evaluated the feasibility, safety, and efficacy of left bundle branch area pacing (LBBAP). Using trans-ventricular septal approach, LBBAP was achieved and was characterized on the electrocardiogram as narrowed QRS duration (QRSd), shortened peak left ventricular activation time (LVAT) and right bundle branch conduction delay. A significant shortening of QRSd and LVAT was induced by LBBAP. Significant improvement in NYHA functional class, plasma levels of B-type natriuretic peptide, left ventricular (LV) end systolic diameter and LVEF was seen on an average follow-up of 6.7 months. Overall, findings revealed the clinical feasibility of LBBAP in patients with systolic HF and LBBB. LBBAP can afford a novel CRT to treat LBBB, provide ventricular synchrony and improve clinical symptoms with LV reverse remodeling.