Left Bundle-Branch Pacing versus Right Ventricular Pacing for Atrioventricular Block.

Left bundle-branch pacing reduces the 4-year risk of death, heart-failure hospitalization, or pacing-induced cardiomyopathy versus right ventricular pacing in 685 atrioventricular block patients.

• Why it matters: Right ventricular pacing can create dyssynchrony and left ventricular dysfunction, while left bundle-branch pacing may preserve synchrony; clinical outcome benefits in atrioventricular block were uncertain.
• What they did: In an international, open-label randomized trial, 702 patients with atrioventricular block were assigned 1:1 to left bundle-branch pacing or right ventricular pacing, with 685 analyzed in a modified intention-to-treat approach.
• The result: Over a median 35.1 months, primary events occurred in 16 vs 35 patients, with Kaplan-Meier 4-year cumulative incidence of 8.5% vs 19.2% (hazard ratio 0.41, 95% CI 0.23–0.75; P=0.003), prompting early termination.

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