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June 27, 2026EP EuropaceOpen Access

LBBaP linked to ~73% lower 6-month mortality vs BiVP but no long-term survival difference.

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Why the study?

Does left bundle branch area pacing (LBBaP) improve long-term overall survival and clinical outcomes compared to biventricular pacing (BiVP) in patients with HFrEF undergoing CRT?

Population

271 patients with heart failure with reduced ejection fraction undergoing cardiac resynchronization therapy…

Comparison

Left bundle branch area pacing (LBBaP) vs Conventional biventricular pacing (BiVP)

Design

Cohort

Follow-up

median 41 months

Key result

Left bundle branch area pacing was associated with lower 6-month all-cause mortality (2.9% vs 10.8%, p=0.047) compared to biventricular pacing, but showed no difference in long-term survival.

Authors

FHF HacizadeUCU CanpolatKAK Kudret Aytemir

Discussion

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Overview

Early mortality lower with LBBaP but long-term survival similar; leaves open superiority over BiVP pending randomized trials.

Key Points

  • To compare the long-term clinical outcomes of left bundle branch area pacing (LBBaP) and biventricular pacing (BiVP) in patients with heart failure with reduced ejection fraction (HFrEF).
  • Retrospective, single-center study, N=271 patients (203 BiVP, 68 LBBaP)
  • Assessment of clinical characteristics, procedural outcomes, and follow-up data from hospital database
  • Kaplan-Meier and Cox regression analyses for survival analysis and prognostic factor identification.
  • LBBaP group had a narrower QRS duration (144±18 ms vs. 153±22 ms; p = 0.005) and lower X-ray dose (124 vs. 244 Gy; p < 0.001)
  • At 6 months, LBBaP showed better NYHA functional class (p=0.006), higher LVEF (37.7±10.8% vs. 33±10.6%; p=0.005), less mitral regurgitation (p=0.005), lower hospitalization (22.6% vs. 36.7%; p=0.042), and lower mortality (2.9% vs. 10.8%; p=0.047)
  • No significant long-term survival difference at 41 months (p=0.289).

Study Design

Type

Cohort (n=271)

Multicenter

No

Structured PICO

Does left bundle branch area pacing (LBBaP) improve long-term overall survival and clinical outcomes compared to biventricular pacing (BiVP) in patients with HFrEF undergoing CRT?

P
Population
271 patients with HFrEF undergoing CRT implantation followed for a median of 41 months.
E
Exposure
Left bundle branch area pacing (LBBaP)
C
Comparator
Conventional biventricular pacing (BiVP)
O
Outcome
Long-term overall survival (all-cause mortality) over a median follow-up of 41 monthshard clinical

Main Result

Absolute Event Rate: 2.9% vs 10.8%

p-value: p=0.047

LBBaP provides superior short-term electrical and echocardiographic improvements compared to BiVP in HFrEF patients, but this does not translate into a long-term overall survival advantage.

Cite This Study

Hacizade et al. (2026) conducted a cohort in heart failure with reduced ejection fraction (HFrEF) (n=271). Left bundle branch area pacing (LBBaP) vs. biventricular pacing (BiVP) was evaluated on all-cause mortality at 6 months (p=0.047). Left bundle branch area pacing was associated with lower 6-month all-cause mortality (2.9% vs 10.8%, p=0.047) compared to biventricular pacing, but showed no difference in long-term survival.

synapsesocial.com/papers/6a3f97bb125782b61d86590ahttps://doi.org/10.1093/europace/euag105.776
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Left Bundle Branch Area Pacing in Cardiac Resynchronization Therapy: How Does It Compare to Biventricular Pacing in Terms of Electrocardiographic Parameters and Procedural Outcomes?2025
  2. 2Comparative outcomes of LBBAP-CRT versus BIV-CRT in a real-world cohort2026
  3. 3Conduction system pacing versus biventricular pacing for cardiac resynchronization: the CSP-SYNC randomized single center study2025 · 20 citations
  4. 4Clinical outcomes of left bundle branch area pacing versus right ventricular pacing in patients with preserved ejection fraction2026
  5. 5Cost‐Utility Analysis of Left Bundle Branch Area Versus Biventricular Pacing for Cardiac Resynchronization Therapy: A Multicenter, Prospective, Quasi‐Experimental Study2025 · 1 citations