Left bundle branch area pacing vs right ventricular pacing for atrioventricular block: the MELOS RELOADED study

作者：Marek Jastrzębski, Grzegorz Kiełbasa, Óscar Cano, Karol Čurila, Francesco Zanon, Cătălin Pestrea, Jan De Pooter, Justin Luermans, Leonard M. Rademakers, David Žižek, Domenico Grieco, Wim Huybrechts, Philipp Krisai, Zachary I. Whinnett, P. Moskal, Valérian Valiton, Javier Navarrete‐Navarro, Petr Štros, Francesco Deluca, Ecaterina Cicală, Emine Özpak, Kevin Vernooy, Haran Burri · 发表于：European Heart Journal · 年份：2025 · DOI：10.1093/eurheartj/ehaf699 · 被引用次数：30 · 研究领域：Cardiac pacing and defibrillation studies、Cardiac Arrhythmias and Treatments、Cardiac electrophysiology and arrhythmias

BACKGROUND AND AIMS: Left bundle branch area pacing (LBBAP) promotes physiological synchronous activation of the left ventricle and may be particularly beneficial in patients with atrioventricular block (AVB), but its mortality benefit remains unclear. This study aims to compare long-term survival in AVB patients receiving either LBBAP or right ventricular pacing (RVP) and to analyse predictors of mortality during LBBAP. METHODS: MELOS RELOADED, a multicentre European collaboration, was a registry-based study of pacemaker patients with AVB, left ventricular ejection fraction (LVEF) >40% and ventricular pacing >20%. The primary outcome was all-cause mortality based on national registries. A 1:1 propensity score matching was performed between the RVP and LBBAP groups. Kaplan-Meier curves and multivariable Cox proportional hazards models were used to estimate survival. RESULTS: In total, 3382 patients receiving LBBAP or RVP were matched. At 4-year follow-up, the Kaplan-Meier curve showed an absolute difference in survival of 11.8% in favour of LBBAP (P < .001). LBBAP was a robust predictor of reduced mortality with a hazard ratio (HR) of 0.53 (95% confidence interval 0.42-0.65, P < .001). Within the LBBAP group, the following independent predictors of increased mortality were identified: lack of confirmed left bundle branch capture (HR 1.85, P < .001), lower percentage of ventricular pacing (HR 1.12), and age. CONCLUSIONS: This is the first large study demonstrating the long-ter...