Left bundle branch area pacing compared with biventricular pacing for cardiac resynchronization therapy in patients with left ventricular ejection fraction ≤50%: Results from the International Collaborative LBBAP Study (I-CLAS)

Morcos, R; Vijayaraman, P; Cano, Ó; Zanon, F; Ponnusamy, SS; Herweg, B; Sharma, PS; Jastrzebski, M; Molina-Lerma, M; Whinnett, ZI; Vernooy, K; Zou, J; Nair, GM; Pathak, RK; Tung, R; Upadhyay, GA; Curila, K; Chelu, MG; Ellenbogen, KA

doi:10.1016/j.hrthm.2025.04.005

Left bundle branch area pacing compared with biventricular pacing for cardiac resynchronization therapy in patients with left ventricular ejection fraction ≤50%: Results from the International Collaborative left bundle branch area pacing (LBBAP) Study (I-CLAS)

Heart RhythmPublished 25 Apr 2025multicenter observational study

Main finding · Composite of all-cause mortality or first heart failure hospitalization (HFH)ResultHazard ratio 0.81 95% CI 0.66–0.98

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Authors' conclusion

LBBAP was associated with superior electrical resynchronization, fewer HFHs, and lower procedural complications compared with BVP in patients with LVEF <50% requiring CRT. Randomized trials are needed to confirm long-term benefits.

Study context

Population: Patients with left ventricular ejection fraction (LVEF) ≤50% receiving cardiac resynchronization therapy (CRT) with either LBBAP or biventricular pacing (BVP) at 18 centers from January 2018 to June 2023propensity score-matched cohort: BVP, 780, LBBAP, 780 · BVP 1,118 · LBBAP 1,461
Participants: 2,579 patients

Exposure: LBBAP vs BVP for CRT
LBBAPn = 780
BVPn = 780reference
Outcome: Composite of:
All-cause mortality
First heart failure hospitalization (HFH)

Methodological detailsPropensity score matching

Propensity score matching

Main finding

As reported in the abstract

Hazard ratio

0.81

95% CI 0.66–0.98

P = 0.048

LBBAPvs BVP

HR 0.81 (95% CI 0.66–0.98); P = 0.048

Observational data: associations, not effects.

Secondary outcomes

Paced QRS duration · shorter with LBBAP

P < 0.001

LBBAP129 ± 19 ms

BVP143 ± 22 ms

Outcome	← Lower risk with LBBAP ←→ Higher risk with LBBAP →	HR (95% CI)	P value
HFH	0.512	0.63 (0.49–0.82)	P < 0.001
All-cause mortality	0.512	0.82 (0.63–1.07)	P = 0.156
	0.512Hazard ratio (log scale)

Safety

Procedural complications · lower with LBBAP

P = 0.004

LBBAP3.5%

BVP6.5%

Original publication

Left bundle branch area pacing compared with biventricular pacing for cardiac resynchronization therapy in patients with left ventricular ejection fraction ≤50%: Results from the International Collaborative LBBAP Study (I-CLAS). Heart Rhythm. Published 25 April 2025. doi:10.1016/j.hrthm.2025.04.005

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