LBBP bests BiVP in Reducing Death or HF Hospitalization in LBBB with Severe LVEF Reduction: JAMA
China: A randomized clinical trial has found that left bundle-branch pacing (LBBP) may lead to better long-term outcomes than conventional biventricular pacing (BiVP) in patients with heart failure and left bundle-branch block (LBBB). The study showed that LBBP significantly reduced the risk of death or hospitalization for heart failure compared with BiVP in patients with severely reduced left ventricular ejection fraction (LVEF).
The findings were published in JAMA Cardiology by Xueying Chen from the Department of Cardiology at Zhongshan Hospital and the Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China, along with colleagues.
Cardiac resynchronization therapy is widely used to improve heart function in patients with heart failure and conduction abnormalities such as LBBB. Traditionally, BiVP has been the standard pacing method. However, LBBP has emerged as a potential alternative because it directly stimulates the heart’s natural conduction system, which may result in more physiological ventricular activation.
To evaluate long-term outcomes, researchers conducted the HeartSync-LBBP randomized clinical trial, a multicenter prospective study across six hospitals in China. The trial enrolled 200 patients with heart failure, LBBB, and an LVEF of 35% or less between October 2020 and March 2022. Participants were randomly assigned in a 1:1 ratio to receive either LBBP or BiVP and were followed for a median of 36 months.
The trial revealed the following findings:
- The study included 200 participants, of whom 136 were men and 64 were women.
- The procedure success rate was high in both groups, reaching 98% for left bundle-branch pacing (LBBP) and 94% for biventricular pacing (BiVP).
- The primary endpoint, defined as the time to death from any cause or hospitalization due to Heart Failure, occurred significantly less frequently in the LBBP group.
- Death or heart failure hospitalization was reported in 8% of patients receiving LBBP, compared with 28% of those treated with BiVP.
- The difference in overall mortality between the two groups was not statistically significant.
- However, hospitalization for heart failure occurred in 7% of patients in the LBBP group compared with 28% in the BiVP group, indicating a markedly lower risk with LBBP.
- Echocardiographic response rates, defined as an improvement in left ventricular ejection fraction (LVEF), were similar between the two treatment groups.
- A higher proportion of patients receiving LBBP achieved a “super response,” defined as a substantial improvement in LVEF or recovery of LVEF to 50% or higher.
The authors acknowledged several limitations, including the fact that all participants were Chinese and that procedures were performed in experienced centers with high implantation success rates. These factors may limit the generalizability of the findings to other populations or clinical settings.
Overall, the trial suggests that LBBP may provide superior long-term outcomes compared with BiVP in patients with heart failure, LBBB, and severely reduced LVEF, although further research is needed to confirm these results.
Reference:
Chen X, Liu X, Li R, et al. Long-Term Outcomes of Left Bundle-Branch Pacing vs Biventricular Pacing in Heart Failure: The HeartSync-LBBP Randomized Clinical Trial. JAMA Cardiol. Published online March 11, 2026. doi:10.1001/jamacardio.2026.0083
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