Impact of a Practice-wide Switch from Traditional Right Ventricular Pacing to Left Bundle Branch Area Pacing

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiac conduction disease requiring permanent pacemaker (n=460). Intervention: Left bundle branch area pacing (LBBAP) vs. Traditional right ventricular pacing (RVP). Primary outcome: All-cause mortality (HR 1.21, 95% CI 0.66-2.23, p=0.5).

David Fritz; Ben Ose; Hannah Zerr; Maci Clark; Caroline Trupp; Amulya Gupta; Ahmed Shahab; Seth H. Sheldon; Amit Noheria

doi:10.19102/icrm.2025.16064

June 1, 2025Journal of Innovations in Cardiac Rhythm ManagementOpen Access

Impact of a Practice-wide Switch from Traditional Right Ventricular Pacing to Left Bundle Branch Area Pacing

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Key result

Practice-wide switch to LBBAP shows no mortality benefit over RVP despite shorter QRS duration.

HR 1.21
95% CI 0.66-2.23
P=0.5
n=460

Figures

Key Points

To evaluate the clinical characteristics and institutional impact of a practice-wide transition from traditional right ventricular pacing to left bundle branch area pacing.
Retrospective review conducted at a single center comparing consecutive patients receiving left bundle branch area pacing (LBBAP) from 2020 to 2023 with historical controls receiving right ventricular pacing (RVP) from 2018 to 2019.
Analyzed baseline clinical features and cardiac metrics across 288 LBBAP patients and 172 RVP control patients.
Baseline age (73.3 ± 10.7 years in LBBAP), body mass index, hypertension, diabetes, and left ventricular ejection fraction (56.9% ± 11.4% in LBBAP) were similar between groups.
The LBBAP group included significantly fewer female patients compared to the RVP group (38% vs. 51%).

Study Design

Type

Cohort (n=460)

Multicenter

No

PICO

P

Population

460 adults requiring permanent pacemakers were retrospectively evaluated to compare left bundle branch area pacing (n=288) versus traditional right ventricular pacing (n=172) with a mean follow-up of 17.1 and 59.2 months, respectively.

I

Intervention / Comparator

Left bundle branch area pacing (LBBAP) vs Traditional right ventricular pacing (RVP)

O

Primary Outcome

All-cause mortality — HR 1.21 (0.66-2.23), p=0.5

Main Result

Hazard Ratio: 1.21 (95% CI 0.66–2.23)

Absolute Event Rate: 8.7% vs 28.5%

p-value: p=0.5

Limitations

Retrospective study design with potential for systematically missing data
Procedures conducted by seven operators without standardized protocols or endpoints
Use of a historical cohort with different durations of follow-up
Imbalances in sex and device distribution between the two groups

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Implication

Should not yet change pacing practice; leaves open whether LBBAP improves outcomes in randomized trials.

Abstract

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Cite This Study

Fritz et al. (2025) conducted a cohort in Cardiac conduction disease requiring permanent pacemaker (n=460). Left bundle branch area pacing (LBBAP) vs. Traditional right ventricular pacing (RVP) was evaluated on All-cause mortality (HR 1.21, 95% CI 0.66-2.23, p=0.5). A practice-wide switch to left bundle branch area pacing resulted in shorter paced QRS durations and similar rates of device-related adverse events compared to traditional right ventricular pacing, with no significant difference in the hazard rate of all-cause mortality.

synapsesocial.com/papers/6a155176d64fa333899f8343 https://doi.org/10.19102/icrm.2025.16064

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Impact of a Practice-wide Switch from Traditional Right Ventricular Pacing to Left Bundle Branch Area Pacing

Figures

Key Points

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Impact of a Practice-wide Switch from Traditional Right Ventricular Pacing to Left Bundle Branch Area Pacing

Figures

Key Points

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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