Heart failure & cardiomyopathies

Long-Term Outcomes of Left Bundle-Branch Pacing vs Biventricular Pacing in Heart Failure: The HeartSync-LBBP Randomized Clinical Trial

JAMA CardiolPublished Randomised controlled trial

Primary result · Death or HFHResult — go to the resultHazard ratio 0.26 95% CI 0.12–0.57

Authors' conclusion

In this study, LBBP was superior to BiVP in reducing the risk of death or HFH in patients with LBBB and severely reduced LVEF.

Study context

Population
HF patients with left bundle-branch block (LBBB) and left ventricular ejection fraction (LVEF) ≤35%, 6 centres in China
Participants
200 patients
Comparison
Left bundle-branch pacing (LBBP) vs biventricular pacing (BiVP)
Primary endpoint
Time to all-cause death or HF hospitalization (HFH)
Methodological detailsmulticentre, prospective
  • Multicentre
  • Prospective

Primary result

Death or HFH · median follow-up 36 months

Hazard ratio

0.26

95% CI 0.12–0.57

P < 0.001

By group

LBBPvs BiVP
HR 0.26 (95% CI 0.12–0.57); P < 0.001

As reported in the abstract

Secondary outcomes

All-cause mortality

No significant difference in all-cause mortality (LBBP vs BiVP)
2.0% vs 5.0%; HR, 0.40; 95% CI, 0.08-2.04; P = .25

Heart failure hospitalization (HFH)

LBBP significantly reduced the risk of HFH (LBBP vs BiVP)
7.0% vs 28.0%; HR, 0.23; 95% CI, 0.10-0.52; P < .001

Echocardiographic response (absolute LVEF increase ≥5%)

Similar in both groups (LBBP vs BiVP)
86.0% vs 81.0%; P = .34

Super response (absolute LVEF increase ≥15% or LVEF improved to ≥50%)

Super-response rate higher with LBBP (LBBP vs BiVP)
55.0% vs 36.0%; P < .007

Original publication

Long-Term Outcomes of Left Bundle-Branch Pacing vs Biventricular Pacing in Heart Failure: The HeartSync-LBBP Randomized Clinical Trial. JAMA Cardiol. Published 1 April 2026. doi:10.1001/jamacardio.2026.0083

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