Two-year outcomes of left bundle branch area pacing versus traditional right ventricular pacing in middle-aged adults: a registry-based trial.

IF 7.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Europace Pub Date : 2025-08-04 DOI:10.1093/europace/euaf181

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, Giorgia Azzolini, Gloria Zuccari, Francesco Zanon, Giuseppe Boriani, Marco Zuin

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引用次数: 0

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).

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中年人左束支区起搏与传统右室起搏的两年结果：一项基于注册的试验。

目的：延长右心室起搏（RVP）增加心肌病、心房颤动、心力衰竭（HF）和死亡率的风险。这项基于注册的试验比较了65岁以下患者的左束分支区域起搏（LBBAP）和RVP。方法和结果：在临床实践中使用当代心脏刺激：左、双心室、右、传导系统起搏（TREEBEARD）注册（NCT06324682），患者按1:1随机分配到LBBAP或RVP。主要终点是心血管（CV）死亡和心衰住院（HFH）的组合；次要终点包括个体成分和全因死亡率。共纳入344例患者（平均年龄58.5岁，男性215例，每组172例）。2年时，主要复合终点发生在6.3%的LBBAP和12.7%的RVP患者中（HR, 0.78; 95% CI, 0.59-0.87），风险降低22%。亚组分析与初步发现一致。左束分支区域起搏显著降低HFH风险（HR, 0.79; 95% CI, 0.63-0.86），但CV死亡率（HR, 1.02; 95% CI, 0.79-1.32）或全因死亡率（HR, 1.00; 95% CI, 0.72-1.38）无差异。结论：与RVP相比，老年患者左束支区起搏可显著降低心血管死亡和HFH的2年复合死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Europace 医学-心血管系统

CiteScore

10.30

自引率

8.20%

发文量

851

审稿时长

3-6 weeks

期刊介绍： EP - Europace - European Journal of Pacing, Arrhythmias and Cardiac Electrophysiology of the European Heart Rhythm Association of the European Society of Cardiology. The journal aims to provide an avenue of communication of top quality European and international original scientific work and reviews in the fields of Arrhythmias, Pacing and Cellular Electrophysiology. The Journal offers the reader a collection of contemporary original peer-reviewed papers, invited papers and editorial comments together with book reviews and correspondence.