Left bundle branch area pacing vs right ventricular pacing in preserved or mildly reduced ejection fraction: the PACE-HF trial

作者：Jenish Shroff, Deep Chandh Raja, Sreevilasam Pushpangadhan Abhilash, Abhinav Mehta, Walter P. Abhayaratna, Pugazhendhi Vijayaraman, Prashanthan Sanders, Rajeev K. Pathak · 发表于：European Heart Journal · 年份：2025 · DOI：10.1093/eurheartj/ehaf724 · 被引用次数：6 · 研究领域：Cardiac pacing and defibrillation studies、Cardiac Arrhythmias and Treatments、Cardiovascular Function and Risk Factors

Chronic right ventricular pacing (RVP) may result in heart failure (HF).1 Advances in pacing strategies, including cardiac resynchronization therapy and, more recently, left bundle branch area pacing (LBBAP), aim to mitigate this risk.2,3 However, evidence supporting LBBAP over RVP in patients with preserved or mildly reduced left ventricular ejection fraction (LVEF) remains largely observational.4 This prospective, randomized, unblinded trial enrolled 120 patients aged ≥18 years with LVEF > 40% and an indication for permanent pacing due to atrioventricular block, tachy-brady syndrome with anticipated ventricular pacing > 40%, or permanent atrial fibrillation (AF) undergoing a ‘pace and ablate’ strategy. Patients were randomized 1:1 to RVP or LBBAP (Figure 1A). The study received ACT human research ethics committee approval, conformed to the Declaration of Helsinki, and was registered with ANZCTR (ACTRN12624001420538). (A) CONSORT flow diagram of the randomized trial. (B) Post hoc analysis of change in left ventricular ejection fraction in subgroups defined by baseline left ventricular function. Among patients with mid-range left ventricular ejection fraction (41%–50%), left bundle branch area pacing (n = 35) resulted in significant improvement from 45.6 ± 3.1% to 54.4 ± 6.6%, while right ventricular pacing (n = 32) showed a decline from 46.1 ± 3.4% to 44.7 ± 6.7% (change in left ventricular ejection fraction: +8.8 ± 8.0% vs −1.5 ± 6.0%; P < .001). In those with preserved lef...