Left Bundle Branch Area Pacing vs. Biventricular Pacing for Cardiac Resynchronization: Propensity Score Analysis

Background Left bundle branch area pacing (LBBAP) has emerged as a promising alternative to conventional biventricular pacing (BIVP) for cardiac resynchronization therapy (CRT). While previous data suggest LBBAP may provide superior outcomes, existing evidence needs more data. Methods This retrospective study included all patients who underwent de‐novo CRT at two centers in France (2022–2024). Procedural and clinical outcomes were compared between LBBAP and BIVP groups for de‐novo CRT indications, using inverse probability weighting propensity score. Results A total of 314 patients were included (75 LBBAP, 239 BIVP). Patients receiving LBBAP were older and more likely to have atrial fibrillation. Compared to BIVP, LBBAP was associated with shorter procedure time (96 vs. 128 min; p < 0.001), narrower paced QRS (128 vs. 139 ms; p < 0.001), and lower post‐discharge device‐related complications (1% vs. 11%; HR 0.10, 95% CI 0.01–0.84; p = 0.033). At 1‐year, improvement in left ventricular ejection fraction (LVEF) was similar between groups (median ΔLVEF +15%; p = 0.438), as were hyper‐response rates (52% vs. 60%; p = 0.231). After IPW‐PS, no significant differences were observed in heart failure hospitalization (HR 0.99, 95% CI 0.40–2.64; p = 0.999), new‐onset atrial fibrillation (HR 1.69, 95% CI 0.41–6.94; p = 0.492), sustained ventricular arrhythmias (HR 1.23, 95% CI 0.15–6.49; p = 0.828), overall (HR 1.10, 95% CI 0.44–2.62; p = 0.801), and cardiovascular deaths (HR 0.92, 95% CI 0.27–2.79; p = 0.927). Conclusion LBBAP is associated with comparable resynchronization and clinical outcomes to BIVP, with fewer late complications.