Left Bundle-Branch Pacing vs Biventricular Pacing: Which Strategy Improves Outcomes in Heart Failure With LBBB?

Left bundle-branch pacing (LBBP) has been proposed as an alternative to biventricular pacing (BiVP) for patients with heart failure and left bundle-branch block (LBBB), but robust randomized clinical evidence comparing long-term outcomes between these pacing strategies remains limited. To address this gap, a study evaluated the long-term clinical outcomes of LBBP versus BiVP in 200 patients with heart failure and LBBB. The study found that the primary end point of time to death or heart failure hospitalization (HFH) was significantly lower in the LBBP group compared with the BiVP group (8% vs 28%; HR, 0.26).

Although all-cause mortality did not differ significantly between groups (2.0% vs 5.0%; HR, 0.40), LBBP significantly reduced the risk of HFH compared with BiVP (7.0% vs 28.0%; HR, 0.23). Echocardiographic response rates were comparable between the two groups (86.0% vs 81.0%);…