New Pacing Approach Cuts Complications in Heart Failure Patients

Cardiac resynchronization therapy (CRT) involves implanting a pacemaker device to help the heart’s chambers pump in synchrony and is used in selected patients with heart failure and electrical dyssynchrony to restore coordinated ventricular contraction. However, a substantial proportion of patients do not respond to standard biventricular pacing. 

Device-related complications can also lead to repeat procedures that burden both patients and healthcare systems, while longer implant times may increase procedural risk and limit throughput. To address these challenges, investigators have evaluated left bundle branch area pacing as an alternative resynchronization strategy.

Left bundle branch area pacing (LBBAP) is a pacing approach intended to restore ventricular synchrony more physiologically than biventricular pacing. Late-breaking data were presented at the 2026 congress of the European Heart Rhythm Association (EHRA), a branch of the European Society of Cardiology. 

The prospective, randomized LECART trial enrolled patients at 11 high-volume centers in Belgium. Eligible participants had New York Heart Association (NYHA) class II–IV heart failure, left ventricular ejection fraction (LVEF) below 40%, and left bundle branch block, with a guideline-based indication for resynchronization. Patients were randomized 1:1 to receive LBBAP or biventricular pacing. The primary endpoint over one year was a composite of all-cause death, heart failure hospitalization, device-related complications requiring surgical re-intervention, or failure to deliver the assigned therapy, and events were adjudicated by an independent blinded committee.

Among 168 randomized patients, mean age was 69 years and 33% were female. Most had class II symptoms, and 77.5% were receiving at least three of the four European guideline pillars of heart failure medication. The primary outcome occurred in 25% of the biventricular group and 13% of the LBBAP group, corresponding to a hazard ratio of 2.14 (95% CI 1.01–4.51; p=0.039).

The difference was mainly driven by device-related complications, which were more frequent with biventricular pacing than with LBBAP (15% vs 1%; odds ratio 6.76; 95% CI 1.48–31.25; p=0.006). There was no significant difference between groups for death, heart failure hospitalization, or implant failure. Mean procedure time was longer with biventricular pacing than with LBBAP (90 vs 76 minutes; p=0.005), while functional improvement was similar in both groups.

“This is the first randomized trial to demonstrate that LBBAP provides effective cardiac synchronization while decreasing the need for surgical re-intervention. The reduction in complications plus shorter procedure times with LBBAP are important both for patients and for the health care system as a whole,” said Jean-Benoît le Polain de Waroux, professor and study presenter at AZ Sint-Jan Hospital, Bruges, Belgium.

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AZ Sint-Jan Hospital
EHRA