Language

English

Publication Date

4-1-2026

Journal

JAMA Cardiology

DOI

10.1001/jamacardio.2026.0083

PMID

41811342

PMCID

PMC12980356

PubMedCentral® Posted Date

3-11-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Importance: Left bundle-branch pacing (LBBP) has been proposed as an alternative to biventricular pacing (BiVP) for patients with heart failure with left bundle-branch block (LBBB). However, robust clinical evidence from randomized clinical trials is lacking.

Objective: To evaluate the long-term clinical outcomes of LBBP and BiVP.

Design, setting, and participants: This multicenter, prospective, randomized clinical trial enrolled 200 patients at 6 centers in China with a left ventricular ejection fraction (LVEF) of 35% or less and LBBB from October 2020 to March 2022. This study was took place from October 2020 to September 2024. These data were analyzed September 2024 to December 2024.

Interventions: Patients were randomly assigned in a 1:1 ratio to receive either LBBP or BiVP.

Main outcomes and measures: The primary end point was the time to death from any cause or heart failure hospitalization (HFH). The secondary end points included all-cause death, HFH, echocardiographic response (absolute increase in LVEF ≥5%), and super response (absolute increase in LVEF ≥15% or improvement of LVEF to ≥50%) rates.

Results: Of the 200 included patients, 136 were male and 64 were female. The success rate was 98% in the LBBP group and 94% in the BiVP group (P = .28). The median follow-up duration was 36 (range, 33-39) months. The primary end point of time to death or HFH was significantly lower in the LBBP group compared with BiVP (8% vs 28%; hazard ratio [HR], 0.26; 95% CI, 0.12-0.57; P < .001). There was no significant difference in all-cause mortality between the groups (2.0% vs 5.0%; HR, 0.40; 95% CI, 0.08-2.04; P = .25). However, LBBP significantly reduced the risk of HFH (7.0% vs 28.0%; HR, 0.23; 95% CI, 0.10-0.52; P < .001). The echocardiographic response rates were similar in both groups (86.0% vs 81.0%; P = .34) but the super-response rate was higher in the LBBP group (55.0% vs 36.0%; P < .007).

Conclusions and relevance: In this study, LBBP was superior to BiVP in reducing the risk of death or HFH in patients with LBBB and severely reduced LVEF. Further trials are warranted in this patient population.

Keywords

Aged, Female, Humans, Male, Middle Aged, Bundle-Branch Block, Cardiac Pacing, Artificial, Cardiac Resynchronization Therapy, China, Echocardiography, Heart Failure, Prospective Studies, Stroke Volume, Treatment Outcome, Ventricular Function, Left

Comments

Trial registration: Chinese Clinical Trial Registry identifier: ChiCTR2000036554.

Published Open-Access

yes

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