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A landmark trial shows left bundle branch (LBB) pacing beats traditional right ventricular pacing for patients with atrioventricular block. The OptimPacing trial, published in the NEJM, found LBB pacing cut the combined risk of death, heart failure hospitalization, and pacing-induced cardiomyopathy by more than half. Researchers say it's time to consider LBB pacing as the go-to first-line strategy for patients with high pacing needs.
For decades, right ventricular (RV) pacing has been the standard approach for patients with atrioventricular block — but a major new trial suggests it's time for a change. The OptimPacing trial, presented at the American Heart Association Scientific Sessions and simultaneously published in the New England Journal of Medicine, found that left bundle branch (LBB) pacing significantly outperformed RV pacing on a composite endpoint of all-cause death, heart failure hospitalization, and pacing-induced cardiomyopathy.
The international randomized trial enrolled 702 patients requiring permanent pacemakers with high ventricular pacing burden. After a median follow-up of 35.1 months, the trial was stopped early due to LBB pacing's clear superiority — with only 16 primary outcome events in the LBB group vs. 35 in the RV group.
By the Numbers:
Why it matters: RV pacing is known to cause left ventricular dyssynchrony and dysfunction over time, leading to preventable heart failure and death. LBB pacing preserves more natural cardiac conduction, and this trial provides the strongest evidence yet that it should become the first-line standard — potentially prompting guideline updates in cardiac electrophysiology.
