Arrhythmias & electrophysiology
Left Bundle-Branch Area Pacing vs Right Ventricular Pacing for Atrioventricular Block and Preserved Left Ventricular Function: The LEAP-Block Randomized Clinical Trial
Authors' conclusion
Among patients with atrioventricular block and preserved LVEF requiring high-burden ventricular pacing, LBBAP was superior to RVP in reducing the risk of the composite end point of all-cause death, HF events, or upgrade to biventricular pacing at 24 months.
Study context
- Population
- Patients with atrioventricular block and preserved left ventricular ejection fraction (LVEF) (≥50%) requiring high-burden ventricular pacing (anticipated ventricular pacing greater than 40%)randomized, of 551 assessed for eligibility, primary analysis included 482 patients (mean age, 67 years, 46% female) · Primary analysis 482
- Participants
- 499 patients
- Comparison
- Left bundle-branch area pacing (LBBAP) vs right ventricular pacing (RVP)
- LBBAPn = 249
- RVPn = 250reference
- Primary endpoint
- Composite of:
- All-cause death
- Heart failure (HF) events
- Upgrade to biventricular pacing
- Follow-up
- 24 months
Methodological details14 Chinese hospitals, 1:1 randomization
- 14 Chinese hospitals
- 1:1 randomization
Primary result
As reported in the abstract
LBBAP vs RVPAbsolute risk difference (95% CI)P value
Composite of all-cause death, HF events, or upgrade to biventricular pacing
−10.1%(−16.8% to −3.4%)
P = 0.003LBBAP vs RVPHazard ratio (95% CI)P value
24-month Kaplan-Meier estimated cumulative incidence 5.0% for LBBAP vs 13.2% for RVP
0.37(0.19–0.73)
P = 0.004Secondary outcomes
| Outcome | LBBAP | RVP | Difference (95% CI) | |
|---|---|---|---|---|
| HF events (secondary)Fewer with LBBAP | 3.4% | 11.3% | −7.9% (−13.0% to −2.8%) | |
| −20−10010Difference (linear scale) |
Acute procedure success
- Acute procedure success: P = .22
All-cause death, biventricular pacing upgrade, device-related complications, pacing-induced cardiomyopathy
- No significant differences
Left bundle-branch capture
- Left bundle-branch capture confirmed
- 188 of 236 patients (79.7%)
Prespecified subgroups
- LBBAP superiority was consistent across all prespecified subgroups
Original publication
Left Bundle-Branch Area Pacing vs Right Ventricular Pacing for Atrioventricular Block and Preserved Left Ventricular Function: The LEAP-Block Randomized Clinical Trial. JAMA. Published 28 October 2026. doi:10.
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