What’s new and important in LBBAP (2023–2025)
1) Long-term outcomes vs RV pacing (large cohorts, 2025).
- European Heart Journal (2025): LBBAP improved long-term survival compared to RVP. (OUP Academic)
- Europace (Aug 2025): Registry-based data show LBBAP reduces adverse events vs RVP. (OUP Academic)
- Review/meta (2025): LBBAP outperforms RVP but trials remain small. (PMC)
2) LBBAP for CRT—how does it stack up to biventricular pacing (BVP)?
- Heart Rhythm (2025, in press): Better resynchronization, fewer HF hospitalizations vs BVP. (Heart Rhythm Journal)
- Heart Rhythm (2024): Feasible and clinically effective with lower capture thresholds. (ScienceDirect)
- Circulation: EP (Oct 2024): LOT-CRT and BVP produced stronger acute hemodynamics. (AHA Journals)
- HRS 2025 Conference: Two trials showed positive efficacy/safety. (HRS)
3) Randomized evidence for CRT with LBB pacing exists—but is still building.
- JACC (LBBP-RESYNC, 2022): Greater LVEF improvement vs BVP-CRT. (JACC)
- 2025 Review of trials: Larger, longer RCTs still needed. (PMC)
4) Special situations & protocols.
- CJC Open (2024): Post-TAVR RCT protocol comparing LBBAP vs RV pacing. (PubMed)
- Heart Rhythm (2025): Echo mechanics: improved LV deformation with LBBAP. (Heart Rhythm Journal)
- Heart Rhythm (2025, retrospective): Preserved EF: LBBAP better preserved LV function. (ScienceDirect)
5) Guidance & consensus you should know.
- ESC Clinical Consensus (2025): CSP—especially LBBAP—preferred in many scenarios. (OUP Academic)
- EHRA Consensus (2023): Practical targets: thresholds <1.5 V @ 0.5 ms. (OUP Academic)
- HVT Journal (2025): LBBAP first-line CSP, HBP for select anatomy. (HVT Journal)
What this means in practice
- Brady pacing: LBBAP generally beats RVP; survival benefit emerging. (OUP Academic)
- CRT candidates: LBBAP-CRT often equal/better vs BVP; substrate matters. (Heart Rhythm Journal, ScienceDirect, AHA Journals)
- Technique quality: Confirming true LBB capture is key. (OUP Academic)
Open questions researchers are chasing
- Head-to-head RCTs of LBBAP vs BVP in LBBB/non-LBBB/TAVR/ischemic CMP. (HRS)
- Anatomy-guided selection for best responders. (AHA Journals)
- Long-term safety and extraction feasibility. (ScienceDirect)
Quick reading list
- ESC Clinical Consensus on CSP (2025). (OUP Academic)
- EHRA Practical Consensus (2023). (OUP Academic)
- LBBAP vs RVP survival (Eur Heart J, 2025). (OUP Academic)
- LBBAP-CRT vs BVP (Heart Rhythm, 2025 & 2024). (Heart Rhythm Journal)
- Hemodynamics (Circulation: EP, 2024). (AHA Journals)
- LBBP-RESYNC RCT (JACC, 2022). (JACC)