Arrhythmias & electrophysiologyRandomised controlled trial
Randomized Trial of Left Bundle Branch Pacing vs Right Ventricular Pacing in Vulnerable Cardiac Function
- Randomised controlled trial
- prospective
- multicentre
Authors' conclusion
In patients with a high pacing burden with high risk of cardiac dysfunction, LBBP significantly reduced the risk of the composite outcome, driven primarily by a decreased risk of PICM, and is associated with better echocardiographic improvements and clinical function.
Study context
- Population
- Patients with a high pacing burden with high risk of cardiac dysfunctionrandomised 1:1
- Participants
- 160 patients
- Comparison
- Left bundle branch pacing (LBBP) vs right ventricular pacing (RVP)
- Primary endpoint
- Composite of:
- All-cause mortality
- HF hospitalization
- Pacing-induced cardiomyopathy (PICM)
- Follow-up
- Median 36 months
Primary result
As reported in the abstract
Hazard ratio
0.310
95% CI 0.145–0.664
P = 0.001
Events by treatment group
LBBP vs RVP
HR 0.310 (95% CI 0.145–0.664); P = 0.001
Secondary outcomes
| Outcome | LBBP | RVP | subdistribution HR (95% CI) | P value | |
|---|---|---|---|---|---|
| PICM | 6.5% | 18.2% | 0.324 (0.119–0.883) | P = 0.028 | |
| 0.10.31310Subdistribution hazard ratio (log scale) |
| Outcome | mean difference (95% CI) | P value | |
|---|---|---|---|
| Echocardiographic change from baseline · 36 months · LVEF | 5.34 (3.18–7.50) | P < 0.001 | |
| Echocardiographic change from baseline · 36 months · LV end-diastolic diameter | −3.06 (−4.38 to −1.73) | P < 0.001 | |
| Echocardiographic change from baseline · 36 months · LV end-systolic diameter | −3.74 (−5.07 to −2.41) | P < 0.001 | |
| −10−50510Difference (linear scale) |
| Outcome | LBBP | RVP | Estimate | P value |
|---|---|---|---|---|
| NYHA functional class · 36 months | 1.66 (SD 0.60) | 1.90 (SD 0.56) | P = 0.014 |
All-cause mortality and HF hospitalization
- No significant difference in all-cause mortality
- P = 0.391
- No significant difference in HF hospitalization
- P = 0.100
Original publication
Randomized Trial of Left Bundle Branch Pacing vs Right Ventricular Pacing in Vulnerable Cardiac Function. J Am Coll Cardiol. Published 23 April 2026. doi:10.1016/j.jacc.2026.03.161
Summarised from the published abstract; every number is checked against it