Left bundle branch area vs biventricular pacing for cardiac resynchronization therapy: the LEFT-BUNDLE-CRT trial.
Óscar Cano, Víctor Pérez-Roselló, Andrea Di Marco et al.
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In 30 seconds
The multicentre, randomized, non-inferiority LEFT-BUNDLE-CRT trial compared left-bundle branch area pacing (LBBAP) with biventricular pacing (BiVP) for cardiac resynchronization in patients with guideline-based indications and typical left-bundle branch block. At 6 months, the primary response endpoint was met by 89.7% with LBBAP and 94.6% with BiVP (RR 0.95; 95% CI 0.88-1.02); LBBAP did not meet the prespecified criterion for non-inferiority. Both groups had high response rates, with similar rates of adverse events and heart failure hospitalization.
Key findings
- The primary endpoint occurred in 89.7% with LBBAP and 94.6% with BiVP (RR 0.95; 95% CI 0.88-1.02); non-inferiority was not established.
- Clinical composite score improved in 68% with LBBAP and 77% with BiVP.
- A ≥15% reduction in left ventricular end-systolic volume occurred in 79% with LBBAP and 85% with BiVP.
- Adverse events and heart failure hospitalization rates were similar between groups.
Why it matters
The trial directly compares a conduction-system pacing approach with established biventricular pacing in patients with typical LBBB who are candidates for CRT. Although response rates were high with both strategies, the study did not establish that LBBAP was non-inferior on its primary endpoint. This distinction is important when interpreting LBBAP as an alternative to BiVP.
What to keep in mind
Crossovers occurred in 26 patients (14.9%), and the primary endpoint was assessed at 6 months.