A Randomized Controlled Trial Comparing Different Programming Strategies of Left Bundle Branch Area Pacing on Left...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Left bundle branch area pacing (LBBAP) offers physiological ventricular synchrony.
• Sinus node dysfunction (SND) patients often have conduction delays, complicating LBBAP programming.
• Minimal ventricular pacing (MVP) algorithms may prolong AV delay, risking left atrial (LA) remodeling and arrhythmias.

Purpose of the Study:

• To compare a fixed optimized AV delay strategy versus MVP in SND patients with LBBAP.
• To assess non-inferiority of optimized AV delay in preventing LA volume increase at 12 months.
• To evaluate the impact on atrial tachyarrhythmias, including atrial high-rate episodes (AHRE) and atrial fibrillation (AF) burden.

Main Methods:

• Prospective, single-center, randomized, open-label trial with blinded endpoint assessment (PROBE design).
• 216 SND patients with successful LBBAP randomized 1:1 to two groups.
• Group 1: Fixed optimized AV delay (paced 150 ms, sensed 120 ms, MVP disabled). Group 2: MVP strategy (paced 200 ms, sensed 150 ms).

Main Results:

• Primary endpoint: Change in left atrial volume (LAV) from baseline to 12 months (non-inferiority analysis).
• Secondary endpoints: Device-detected AHRE and AF burden.
• Study designed to provide insights into optimal LBBAP programming for atrial health.

Conclusions:

• The trial will determine if active AV synchrony optimization post-LBBAP is non-inferior to MVP for LA remodeling.
• It will also assess if optimized AV synchrony reduces the burden of atrial arrhythmias.
• Findings will guide programming strategies for LBBAP in SND patients.