LBBP Outperforms Right Ventricular Pacing in Trial

A randomized trial published in JACC compared left bundle branch pacing (LBBP) with right ventricular pacing (RVP) in patients with a high anticipated pacing burden and risk factors for deterioration of cardiac function. The study evaluated whether the more physiological activation produced by LBBP could reduce adverse outcomes associated with RVP.

Investigators enrolled 160 patients at 3 centers in China and randomly assigned them 1:1 to LBBP or RVP. Eligible patients had an anticipated ventricular pacing percentage greater than 40% and at least 1 risk factor for cardiac function deterioration. The primary endpoint was a composite of all-cause mortality, heart failure hospitalization, or pacing-induced cardiomyopathy (PICM).

During a median follow-up of 36 months, the primary endpoint occurred in 11.6% of the LBBP group and 33.9% of the RVP group (P=.001). The difference was driven primarily by PICM, which occurred in 6.5% and 18.2% of patients, respectively. No significant between-group differences were observed in all-cause mortality or heart failure hospitalization.

LBBP also produced greater improvements in left ventricular ejection fraction and left ventricular dimensions through 36 months. Implantation was successful in both groups, and no major complications were reported. However, lead-placement attempts, procedure time, fluoroscopy time, and flouroscopic dose were higher with LBBP. The authors noted that the procedures were performed at experienced centers, which may limit generalizability to centers without similar technical expertise.

The authors said the findings provide randomized evidence supporting consideration of LBBP rather than RVP as an initial pacing strategy in this high-risk population. They also called for larger trials designed to evaluate heart failure hospitalization, mortality, and more precisely defined patient populations.

Source: Qiu N, Liu X, Wang Z, et al. Randomized trial of left bundle branch pacing vs right ventricular pacing in vulnerable cardiac function. J Am Coll Cardiol. 2026;88(2):188-201. doi:10.1016/j.jacc.2026.03.161