Cardiology · 2 h ago
LBBAP Reduces 24-Month Composite Events vs Right Ventricular Pacing
In the randomized LEAP-Block trial, 499 patients with atrioventricular block, preserved LVEF, and anticipated high-burden pacing were assigned to left bundle-branch area pacing (LBBAP) or right ventricular pacing (RVP). At 24 months, the composite of death, heart failure events, or upgrade to biventricular pacing was less frequent with LBBAP, largely alongside fewer heart failure events.
- Randomized trial enrolled 499 patients with preserved LVEF.
- Primary composite: 2.4% with LBBAP vs 12.5% with RVP.
- Heart failure events were less frequent with LBBAP.
- No significant differences in death or device complications.
The prospective, multicenter, randomized superiority trial enrolled patients at 14 hospitals in China from 2021 to 2025. Of 499 patients with LVEF of at least 50% and anticipated ventricular pacing greater than 40% who were randomized, the primary analysis included 482: 242 assigned to LBBAP and 240 to RVP. The primary endpoint was a composite of all-cause death, heart failure events, or upgrade to biventricular pacing at 24 months.
The primary endpoint occurred in 2.4% of the LBBAP group and 12.5% of the RVP group (absolute risk difference, −10.1 percentage points; 95% CI, −16.8 to −3.4; P=.003). Heart failure events were also less frequent with LBBAP (3.4% vs 11.3%). The estimated 24-month cumulative incidence was 5.0% versus 13.2% (hazard ratio, 0.37; 95% CI, 0.19-0.73). There were no significant between-group differences in death, biventricular pacing upgrade, device complications, or pacing-induced cardiomyopathy.
Acute procedural success was comparable, and left bundle-branch capture was confirmed in 79.7% of assessed LBBAP patients. The findings support LBBAP as a potential pacing strategy for this selected population, but follow-up was 24 months and the composite result was accompanied by fewer heart failure events; individual mortality and upgrade outcomes did not differ significantly. Applicability beyond the participating Chinese hospitals requires consideration.
In practice
For patients with atrioventricular block, LVEF of at least 50%, and anticipated ventricular pacing above 40%, this randomized trial found fewer 24-month composite events with left bundle-branch area pacing than with right ventricular pacing. The difference coincided with fewer heart failure events; mortality and biventricular upgrade did not differ significantly. These findings may inform pacing-strategy discussions for this population, but they do not establish benefit for patients outside the study criteria. Follow-up was limited to 24 months, and the trial was conducted at 14 hospitals in China.
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JAMA: Left Bundle-Branch Area Pacing vs Right Ventricular Pacing for Atrioventricular Block and Preserved Left Ventricular Function ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.