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June 27, 2026EP EuropaceOpen Access

LBBAP linked to ~81% less PICM vs RVP, with no difference in the primary composite.

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Why the study?

Does left bundle branch area pacing reduce adverse clinical outcomes compared to right ventricular pacing in patients with preserved ejection fraction requiring permanent pacemaker implantation?

Population

242 de novo patients with left ventricular ejection fraction >50% undergoing transvenous permanent pacemaker…

Comparison

Left bundle branch area pacing (LBBAP) vs Right ventricular pacing (RVP)

Design

Cohort

Follow-up

median three years

Key result

Left bundle branch area pacing reduced pacing-induced cardiomyopathy compared to right ventricular pacing (1.7% vs. 8.8%; p=0.003), with no difference in the primary composite clinical outcome.

Authors

KSK I M Sung SooJKJ E O N G Hyung Ki

Discussion

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Overview

In patients with preserved ejection fraction requiring permanent pacing, LBBAP significantly reduces the risk of pacing-induced cardiomyopathy compared to RVP, despite no difference in the overall composite clinical outcome.

Key Points

  • This study aimed to compare clinical outcomes of left bundle branch area pacing and right ventricular pacing in patients with preserved ejection fraction.
  • Prospective registry at a university hospital in South Korea.
  • Included 242 patients with left ventricular ejection fraction >50% who underwent permanent pacemaker implantation.
  • Analyzed composite endpoints including mortality, hospitalization for heart failure, pacing-induced cardiomyopathy, and upgrades to biventricular pacing.
  • The LBBAP group showed significantly shorter paced QRS duration compared to the RVP group (129.1 ms vs. 157.5 ms; p < 0.001).
  • Incidence of pacing-induced cardiomyopathy was lower in the LBBAP group (1.7% vs. 8.8%; p = 0.003).
  • Overall composite clinical outcomes did not differ between the groups.

Study Design

Type

Cohort (n=242)

Multicenter

No

Structured PICO

Does left bundle branch area pacing reduce adverse clinical outcomes compared to right ventricular pacing in patients with preserved ejection fraction requiring permanent pacemaker implantation?

P
Population
242 patients with preserved ejection fraction (>50%) and expected ventricular pacing burden >20% undergoing permanent pacemaker implantation, followed for a median of 3 years.
E
Exposure
Left bundle branch area pacing (LBBAP)
C
Comparator
Right ventricular pacing (RVP)
O
Outcome
Composite of all-cause mortality, heart failure hospitalization (HHF), pacing-induced cardiomyopathy (PICM), and upgrades to biventricular pacing (BVP)composite

In patients with preserved ejection fraction requiring permanent pacing, LBBAP significantly reduces the risk of pacing-induced cardiomyopathy compared to RVP, despite no difference in the overall composite clinical outcome.

Cite This Study

Soo et al. (2026) conducted a cohort in Preserved ejection fraction requiring permanent pacemaker implantation (n=242). Left bundle branch area pacing (LBBAP) vs. Right ventricular pacing (RVP) was evaluated on Composite of all-cause mortality, heart failure hospitalization, pacing-induced cardiomyopathy, and upgrades to biventricular pacing. Left bundle branch area pacing reduced pacing-induced cardiomyopathy compared to right ventricular pacing (1.7% vs. 8.8%; p=0.003), with no difference in the primary composite clinical outcome.

synapsesocial.com/papers/6a3f97ce125782b61d865a2chttps://doi.org/10.1093/europace/euag105.671
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Also Consider

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

  1. 1Effect of left bundle branch area pacing on cardiac remodeling and function: propensity score matching with right ventricular pacing2025
  2. 2Two-year outcomes of left bundle branch area pacing versus traditional right ventricular pacing in middle-aged adults: a registry-based trial2025 · 24 citations
  3. 3Characteristics of Cardiomyopathy in Patients With Chronic Left Bundle Branch Block Undergoing Right Ventricular Pacing2025
  4. 4Comparison of long-term outcomes of patients with heart failure with reduced ejection fraction undergoing cardiac resynchronization therapy with left bundle branch area pacing or biventricular pacing2026
  5. 5Safety profile of left bundle branch area pacing compared with other pacing modalities: acute and long-term outcomes2026