Left bundle branch area vs biventricular pacing for cardiac resynchronization therapy: the LEFT-BUNDLE-CRT trial.

In CRT candidates with typical left bundle branch block, left-bundle branch area pacing did not meet non-inferiority versus biventricular pacing for 6-month positive response (89.7% vs 94.6%).

• Why it matters: Conduction system pacing is a potential alternative to biventricular pacing, but it is unclear whether left-bundle branch area pacing can match CRT response in guideline-eligible patients with left bundle branch block.
• What they did: In a multi-centre randomized non-inferiority trial of 176 patients, investigators assigned BiVP-CRT (n=84) or LBBAP-CRT (n=92); the primary endpoint was positive CRT response at 6 months (improved CCS or ≥15% LVESV reduction).
• The result: The primary endpoint occurred in 94.6% with BiVP-CRT and 89.7% with LBBAP-CRT (RR 0.95; 95% CI 0.88–1.02), so non-inferiority was not met, while adverse events and heart failure hospitalization were similar.

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