Two-year outcomes of left bundle branch area pacing versus traditional right ventricular pacing in middle-aged adults: a registry-based trial
Matteo Bertini, Luca Canovi, Francesco Vitali, Lina Marcantoni, Gianni Pastore, Mario Volpicelli, Orlando Munciguerra, Mauro Biffi, Matteo Ziacchi, Luca Rossi, Valeria Carinci, Paolo Sirugo, Paolo Pastori, Jacopo Francesco Imberti, Pier Luigi Pellegrino, Erminia Guerriero, Biagio Sassone, Enrico Bertagnin, Giuseppe Coppola, Michele Malagù, Cristina Balla, G Azzolini, Gloria Zuccari, Francesco Zanon, Giuseppe Boriani, Marco Zuin
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).