What type of study is this?

This is a Registry-based trial study.

September 10, 2025Open Access

Two-year outcomes of left bundle branch area pacing versus traditional right ventricular pacing in middle-aged adults: a registry-based trial

Key Points

Left bundle branch area pacing significantly reduced the composite endpoint of cardiovascular death and heart failure hospitalization compared to right ventricular pacing.
At two years, the composite endpoint occurred in 6.3% of left bundle branch area pacing patients versus 12.7% in right ventricular pacing patients, indicating a 22% risk reduction.
The randomized trial utilized data from the TREEBEARD registry, comparing outcomes between two pacing methods in patients under 65 years old.
These findings suggest that while left bundle branch area pacing lowers the risk of heart failure hospitalizations, it does not impact overall mortality compared to right ventricular pacing.

Abstract

Abstract Aims Prolonged right ventricular pacing (RVP) increases the risk of cardiomyopathy, atrial fibrillation, heart failure (HF), and mortality. This registry-based trial compared left bundle branch area pacing (LBBAP) with RVP in patients younger than 65 years. Methods and results Using the ConTempoRary Cardiac Stimulation in Clinical practicE: lEft, BivEntriculAr, Right, and conDuction System Pacing (TREEBEARD) registry (NCT06324682), patients were randomized 1:1 to LBBAP or RVP. The primary endpoint was a composite of cardiovascular (CV) death and HF hospitalization (HFH); secondary endpoints included individual components and all-cause mortality. A total of 344 patients (mean age 58.5 years, 215 males, 172 per arm) were included. At 2 years, the primary composite endpoint occurred in 6.3% of LBBAP vs. 12.7% of RVP patients (HR, 0.78; 95% CI, 0.59–0.87), representing a 22% risk reduction. Subgroup analyses aligned with primary findings. Left bundle branch area pacing significantly reduced HFH risk (HR, 0.79; 95% CI, 0.63–0.86) but showed no difference in CV mortality (HR, 1.02; 95% CI, 0.79–1.32) or all-cause mortality (HR, 1.00; 95% CI, 0.72–1.38). Conclusion Left bundle branch area pacing significantly lowered the 2-year composite of CV death and HFH compared to RVP in patients aged 65 years old. However, it did not reduce CV or all-cause mortality individually compared to RVP. Clinical Trial Registration TREEBEARD (NCT06324682)

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