Left Bundle-Branch Area Pacing vs Right Ventricular Pacing for Atrioventricular Block and Preserved Left Ventricular Function: The LEAP-Block Randomized Clinical Trial.

In the LEAP-Block randomized trial of 499 Chinese patients with atrioventricular block and preserved LVEF (≥50%) needing >40% ventricular pacing, LBBAP reduced the 24-month composite endpoint (2.4% vs 12.5%).

• Why it matters: High-burden ventricular pacing in atrioventricular block is linked to heart failure and mortality risk, but whether left bundle-branch area pacing improves outcomes versus right ventricular pacing is uncertain.
• What they did: Across 14 Chinese hospitals (Jan 2021–Aug 2025), 249 were randomized to LBBAP and 250 to RVP, with 24-month follow-up and a primary composite of all-cause death, HF events, or upgrade to biventricular pacing.
• The result: LBBAP lowered the primary endpoint (absolute risk difference -10.1% [95% CI, -16.8% to -3.4%]; P=.003) and reduced HF events (3.4% vs 11.3%), with Kaplan-Meier incidence 5.0% vs 13.2% (HR 0.37; P=.004).