{"id":"46027","type":"article","url":"https://hartvaat.nl/2026/04/14/left-bundle-crt-linkerbundeltak-pacing-niet-aantoonbaar-non-inferieur-aan-bivent/","title":"LEFT-BUNDLE-CRT: linkerbundeltak-pacing niet aantoonbaar non-inferieur aan biventriculaire CRT","title_en":"Left bundle branch area vs biventricular pacing for cardiac resynchronization therapy: the LEFT-BUNDLE-CRT trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehag225","source_url":"https://doi.org/10.1093/eurheartj/ehag225","authors":["Óscar Cano","Víctor Pérez-Roselló","Andrea Di Marco","Javier Ramos-Maqueda","Pablo Moriña","Thomas Brouzet","Daniel Rodríguez-Muñoz","Víctor Castro","Sebastian Giacoman","Pablo Peñafiel","María Rodríguez-Serrano","Manuel Molina-Lerma"],"significance":7,"published":"2026-07-14","source_date":"2026-04-14","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/bundeltakblok/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This randomized non-inferiority trial compared left-bundle branch area pacing (LBBAP) with biventricular pacing (BiVP) for cardiac resynchronization therapy in 176 patients with a CRT indication and typical left bundle branch block. The primary endpoint (CRT response at six months) was met in 94.6% with BiVP and 89.7% with LBBAP; non-inferiority of LBBAP was not demonstrated (RR 0.95; 95% CI 0.88–1.02). Both strategies yielded high response rates and similar clinical outcomes and complications. LBBAP remains a reasonable alternative, but this evidence does not support non-inferiority to BiVP.","created":"2026-07-03T20:27:07Z","updated":"2026-07-04T19:27:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Deze gerandomiseerde non-inferioriteitstrial vergeleek linkerbundeltak-area-pacing (LBBAP) met biventriculaire pacing (BiVP) voor cardiale resynchronisatietherapie bij 176 patiënten met een CRT-indicatie en typisch linkerbundeltakblok. Het primaire eindpunt (CRT-respons na zes maanden) werd bereikt bij 94,6% met BiVP en 89,7% met LBBAP; non-inferioriteit van LBBAP werd niet aangetoond (RR 0,95; 95%-BI 0,88–1,02). Beide strategieën gaven hoge responspercentages en vergelijkbare klinische uitkomsten en complicaties. LBBAP blijft een redelijk alternatief, maar dit bewijs ondersteunt geen non-inferioriteit ten opzichte van BiVP.","abstract_original":"BACKGROUND AND AIMS: Conduction system pacing has emerged as an alternative to biventricular pacing (BiVP) for cardiac resynchronization therapy (CRT). The left-bundle CRT trial evaluated whether left-bundle branch area pacing (LBBAP) is non-inferior to BiVP in patients eligible for CRT. METHODS: The left-bundle CRT trial was a multi-centre, randomized, investigator-initiated, and non-inferiority study. Patients with guideline-based CRT indications and left-bundle branch block per Strauss criteria were randomized to BiVP-CRT or LBBAP-CRT. The primary endpoint was the proportion of patients with a positive CRT response at 6-months, defined as either an improved clinical composite score (CCS) or a ≥15% reduction in left ventricular end-systolic volume. The non-inferiority margin was the lower bound of the 95% confidence interval (CI) and was set at 10%. Patients were followed for 12-months; secondary endpoints included echocardiographic, clinical, and quality-of-life outcomes. RESULTS: The baseline characteristics of the 176 patients randomized to BiVP-CRT (n=84) or LBBAP-CRT (n=92) were similar, except for a wider intrinsic QRS in the LBBAP group: median 172 ms [IQR 158-184] vs. 165 ms [152-180]; P=0.04. Crossovers occurred in 26 patients (14.9%). In the intention-to-treat analysis, the primary endpoint was achieved in 94.6% of BiVP-CRT and 89.7% of LBBAP-CRT patients (RR 0.95; 95% CI 0.88-1.02), not meeting non-inferiority. CCS improved in 77% and 68% of patients randomized to BiVP-CRT and LBBAP-CRT, respectively and 85% and 79% had a ≥15% reduction in left ventricular end-systolic volume. Rates of adverse events and heart failure hospitalization were similar between groups. CONCLUSIONS: In CRT candidates with typical LBBB, LBBAP-CRT was not shown to be non-inferior to BiVP-CRT. Both strategies yielded high response rates and similar clinical outcomes."}