Left bundle branch area pacing was found to be an effective and practical strategy for cardiac resynchronization, according to a presentation on Apr. 15 at EHRA 2026, the annual congress of the European Heart Rhythm Association, which is a branch of the European Society of Cardiology.
The findings are significant because cardiac resynchronization therapy (CRT) is used in patients with heart failure who continue to have symptoms despite following medical guidelines. CRT aims to help the chambers of the heart pump together by implanting a pacemaker device. It is especially recommended for those with reduced left ventricular ejection fraction and an electrocardiogram pattern called 'left bundle branch block.'
The LECART trial was conducted at 11 centers in Belgium and included patients with NYHA functional class II−IV heart failure, LVEF less than 40%, left bundle branch block, and an indication for CRT under current guidelines. Patients were randomized to receive either left bundle branch area pacing (LBBAP) or biventricular pacing. The primary outcome over one year measured death from any cause, hospitalization due to heart failure, device-related complications requiring surgical re-intervention, or failure to deliver assigned therapy efficiently.
Among the 168 participants—average age 69 years and one-third female—most had moderate symptoms and were on multiple recommended medications. Over one year after implantation, the primary outcome occurred in 25% of those receiving biventricular pacing compared with only 13% among those given LBBAP. This difference was mainly due to more device-related complications in the biventricular group (15%) compared with LBBAP (1%). Procedure times were also shorter for LBBAP recipients.
Professor le Polain de Waroux said: "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 healthcare system as a whole."
