Left Bundle-Branch Area Pacing vs Right Ventricular Pacing in Atrioventricular Block

A randomized trial found that left bundle-branch area pacing (LBBAP) significantly reduced the risk of major clinical events, particularly heart failure (HF) events, compared with right ventricular pacing (RVP) in patients with atrioventricular block, preserved left ventricular ejection fraction (LVEF ≥50%), and an anticipated high ventricular pacing burden. The trial enrolled 499 patients across 14 hospitals in China, with 482 included in the primary analysis, and compared outcomes over 24 months. The primary composite endpoint of all-cause death, HF events, or upgrade to biventricular pacing occurred in 2.4% of patients receiving LBBAP versus 12.5% receiving RVP, an absolute risk reduction of 10.1 percentage points. The estimated 24-month cumulative incidence was 5.0% versus 13.2%, respectively, with a hazard ratio of 0.37. HF events were less frequent with LBBAP (3.4% vs 11.3%). However, no statistically significant differences were observed in all-cause mortality, upgrades to biventricular pacing, device-related complications, or pacing-induced cardiomyopathy. These findings suggest that LBBAP may be a preferable pacing strategy for patients with atrioventricular block and preserved LVEF who are expected to require frequent ventricular pacing. Source: https://jamanetwork.com/