Left bundle branch area pacing (LBBAP) is an established form of physiologic pacing. Our group has reported on positive structural remodeling associated with LBBAP, but it is unknown whether implantation characteristics of LBBAP are predictive of subsequent ventricular function. To evaluate the effects of implant morphology and LBBAP on heart function as measured by standard 2D-echocardiography. Consecutive patients undergoing LBBAP implantation between Jan 2019 and July 2022 at Virginia Commonwealth University were analyzed. Ejection fraction (EF%), left ventricular end-diastolic dimension (LVIDd), and end-systolic dimension (LVIDs) as a function of paced morphology in V1 (qR, RSR, QS) were recorded. Patients with moderate to severe valvular regurgitation were evaluated irrespective of paced morphology. Regurgitation severity was coded on a three point scale, with moderate as ‘2’ and severe as ‘3’. A total of 247 patients with LBBAP had echocardiographic data and implant morphology available, with mean ventricular pacing burden of 67%. Mean follow up duration was 613 days ± 478 days. 29 patients had QS morphology at implant, with mean pre-implant EF of 56.8% ± 9.7% vs 57.0% ± 8.1% after implantation (p=0.821). In the 145 patients with qR morphology the mean pre and post-EF was 54.8% ± 10.8% vs 55.5% ± 7.9% (p=0.400). In the 73 patients with rSR morphology the pre-implant EF was 55.2% ± 10.9% vs 54.5% ± 10% (p=0.257). Left ventricular cavity measurements can be found in Table 1. In patients with moderate to severe tricuspid regurgitation (n=25) the mean severity was 2.16 ± 0.37 prior to LBBAP, and decreased to 1.28 ± 0.93 post-implant (p<0.001). Patients with moderate to severe MR (n=37) likewise decreased regurgitant severity from 2.16 ± 0.37 to 1.46 ± 0.83 (p<0.001). V1 paced morphology at time of implant was not associated with significant change in post-procedural systolic function or left ventricular dimensions. Conduction system pacing via LBBAP was associated with improved valvular regurgitation.