Evidence map›Paper›PMID 40288475›Full record

Observational studyHeart rhythm2025

Left bundle branch area pacing compared with biventricular pacing for cardiac resynchronization therapy in patients with left ventricular ejection fraction ≤50%: Results from the International Collaborative LBBAP Study (I-CLAS).

Ramez Morcos, Pugazhendhi Vijayaraman, Óscar Cano, Francesco Zanon, Shunmuga Sundaram Ponnusamy, Bengt Herweg, Parikshit S Sharma, Marek Jastrzebski, Manuel Molina-Lerma, Zachary I Whinnett and 9 more

Registry-linked trialAbstract readMulticenter StudyObservational StudyComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Heart rhythm, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07604727 (AV Nodal Ablation With Conduction System Pacing Versus Cardiac Resynchronization for Symptomatic Heart Failure Patients With Atrial Fibrillation), which is not on this map. Cited by 11 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07604727 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

AV Nodal Ablation With Conduction System Pacing Versus Cardiac Resynchronization for Symptomatic Heart Failure Patients With Atrial Fibrillation: The APAF-CSP All-cause Mortality and Quality of Life Trial

TypeinterventionalSponsorUniversity Medical Center GroningenRan2026 to 2030Enrolled292ConditionsAtrial Fibrillation (AF), Heart Failure, Cardiac PacingArmsConduction System Pacing, Cardiac resynchronization therapy
3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Conduction system pacing for cardiac resynchronization therapy: a systematic review.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026
    Pooled it
  2. Pooled it
  3. Conduction System Pacing Versus Biventricular Cardiac Resynchronization in HFmrEF: A Systematic Review and Meta-Analysis.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2026
    Pooled it
  4. Pooled it
  5. Review
  6. Article
  7. Article
  8. Improved outcomes of left bundle branch pacing compared to left ventricular septal pacing in patients with heart failure: a systematic review and meta-analysis.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
    Article
  9. Article
  10. Article
  11. Modulation of Redox-Sensitive Cardiac Ion Channels.Antioxidants (Basel, Switzerland) · 2025
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Ramez MorcosGeisinger Heart Institute, Wilkes-Barre, Pennsylvania.
Pugazhendhi VijayaramanGeisinger Heart Institute, Wilkes-Barre, Pennsylvania. Electronic address: pvijayaraman1@geisinger.edu.
Óscar CanoHospital Universitari i Politècnic La Fe, Valencia, Spain, and Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
Francesco ZanonSanta Maria Della Misericordia Hospital, Rovigo, Italy.
Shunmuga Sundaram PonnusamyVelammal Medical College Hospital and Research Institute, Madurai, India.
Bengt HerwegUniversity of South Florida Morsani College of Medicine, Tampa, Florida.
Parikshit S SharmaCleveland Clinic, Weston, Florida.
Marek JastrzebskiJagiellonian University in Krakow, Krakow, Poland.
Manuel Molina-LermaHospital Universitario Virgen de las Nieves, Granada, Spain.
Zachary I WhinnettNational Heart and Lung Institute, Imperial College London, London, United Kingdom.
Kevin VernooyMaastricht University Medical Center, Maastricht, The Netherlands.
Jiangang ZouThe First Affiliated Hospital of Nanjing Medical University, Cardiology, Nanjing, Jiangsu, China.
Girish M NairUniversity of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Rajeev K PathakAustralian National University and Canberra Heart Rhythm, Garran, Australian Capital Territory, Australia.
Roderick TungUniversity of Arizona College of Medicine-Phoenix, Phoenix, Arizona.
Gaurav A UpadhyayThe University of Chicago Medicine, Chicago, Illinois.
Karol CurilaCardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic, Praha, Czechia.
Mihail G CheluBaylor College of Medicine, Houston, Texas.
Kenneth A EllenbogenVirginia Commonwealth University Medical Center, Richmond, Virginia.

Funding

Mechanisms of Lamin A/C-mediated Cardiac Conduction DisordersR01HL166832 · NHLBI · BAYLOR COLLEGE OF MEDICINE · PI Mihail Gabriel Chelu · 2024 to 2026
$1.9M
NHLBI NIH HHS R01 HL166832
6 · The paper itself

Abstract

backgroundCardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is an established treatment of heart failure with reduced ejection fraction and wide QRS. Left bundle branch area pacing (LBBAP) has emerged as a physiologic alternative by directly engaging the His-Purkinje system, potentially improving electrical resynchronization and clinical outcomes.

objectiveThe aim of the study was to compare the clinical outcomes between BVP and LBBAP in patients with left ventricular ejection fraction (LVEF) ≤50% undergoing CRT.

methodsThis multicenter observational study included patients with LVEF ≤50% receiving CRT with either LBBAP or BVP at 18 centers from January 2018 to June 2023. The primary outcome was a composite of all-cause mortality or first heart failure hospitalization (HFH). Secondary outcomes included separate analyses of HFH and all-cause mortality. Propensity score matching was used to balance baseline characteristics. Kaplan-Meier curves, Cox proportional hazards models, and competing risk analyses were performed.

resultsA total of 2579 patients were included (BVP, 1118; LBBAP, 1461). In the propensity score-matched cohort (BVP, 780; LBBAP, 780), LBBAP demonstrated shorter paced QRS duration (129 ± 19 ms vs 143 ± 22 ms; P < .001). LBBAP was associated with a significantly lower risk of the composite primary outcome (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.66-0.98; P = .048) and reduced HFH (HR, 0.63; 95% CI, 0.49-0.82; P < .001). No significant difference in all-cause mortality was observed (HR, 0.82; 95% CI, 0.63-1.07; P = .156). Procedural complications were lower with LBBAP (3.5% vs 6.5%, P = .004).

conclusionLBBAP was associated with superior electrical resynchronization, fewer HFHs, and lower procedural complications compared with BVP in patients with LVEF <50% requiring CRT. Randomized trials are needed to confirm long-term benefits.

Indexed as

Bundle of HisCardiac Resynchronization TherapyHeart FailureStroke VolumeVentricular Function, LeftAgedFemaleFollow-Up StudiesHumansMaleMiddle AgedRetrospective StudiesTreatment OutcomeBiventricular pacingCardiac resynchronization therapyHeart failure hospitalizationLeft bundle branch area pacingMortality

Identifiers

PMID40288475
PMCPMC13251317

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.