Arrhythmias & electrophysiologyCohort study
Left bundle branch area pacing vs right ventricular pacing for atrioventricular block: the MELOS RELOADED study
- Registry-based cohort study
- multicentre
- propensity-score matched
Authors' conclusion
This is the first large study demonstrating the long-term survival benefit of LBBAP.
Study context
- Population
- Pacemaker patients with atrioventricular block (AVB), left ventricular ejection fraction (LVEF) >40% and ventricular pacing >20%, European registrymatched cohort
- Participants
- 3,382 patients
- Exposure
- Left bundle branch area pacing (LBBAP) vs right ventricular pacing (RVP)
- Outcome
- All-cause mortality (national registries)
Main finding
As reported in the abstract
All-cause mortality · 4-year follow-up
LBBAP vs RVPHazard ratio (95% CI)P value
All-cause mortality
0.53(0.42–0.65)
P < 0.001- Kaplan-Meier, in favour of LBBAP
- absolute difference in survival 11.8%; P < 0.001
Observational data: associations, not effects.
Further findings
Predictors of increased mortality within LBBAP
- Lack of confirmed left bundle branch capture, HR
- 1.85, P < .001
- Lower percentage of ventricular pacing, HR
- 1.12
- Age (independent predictor)
Original publication
Left bundle branch area pacing vs right ventricular pacing for atrioventricular block: the MELOS RELOADED study. Eur Heart J. Published 22 September 2025. doi:10.1093/eurheartj/ehaf699
Summarised from the published abstract; every number is checked against it