(c) 2026 David Prutchi, PhD
The LEAP-Block randomized trial, published in JAMA on October 28, compared left bundle-branch area pacing with conventional right ventricular pacing in patients with atrioventricular block, left ventricular ejection fraction of at least 50%, and an anticipated ventricular pacing burden above 40%. Investigators at 14 Chinese hospitals randomized 499 patients, with 482 included in the primary analysis. At 24 months, the Kaplan-Meier estimated incidence of death, heart failure events, or upgrade to biventricular pacing was 5.0% with left bundle-branch area pacing versus 13.2% with right ventricular pacing, corresponding to a hazard ratio of 0.37.
The difference was principally associated with fewer heart failure events. Death, pacing-induced cardiomyopathy, device complications, and upgrades to biventricular pacing did not differ significantly when examined separately. The results strengthen the clinical rationale for avoiding conventional ventricular activation patterns in patients expected to require frequent pacing.