J Am Heart Assoc. 2026 Nov 12:e050375. doi: 10.1161/JAHA.126.050375. Online ahead of print.

ABSTRACT

BACKGROUND: Atrioventricular block with normal cardiac function is common with right ventricular pacing, which raises risks of pacing-induced cardiomyopathy and symptomatic heart failure in some patients with high pacing burden. Left bundle-branch area pacing demonstrates protective potential to reduce the risk of heart failure on the basis of observational studies. Evidence from a large multicenter randomized controlled trial remains limited.

METHODS: The LEAP-Block (Impact of Left Bundle Branch Area Pacing Versus Right Ventricular Pacing in Atrioventricular Block) study is a prospective multicenter, investigator-initiated randomized controlled trial aiming to verify the hypothesis that left bundle-branch area pacing might have superior impact to right ventricular pacing in reducing the risk of cardiovascular events in patients with atrioventricular block requiring high burden of ventricular pacing and left ventricular ejection fraction ≥50%. A total of 484 patients will be randomized to either left bundle-branch area pacing or right ventricular pacing (1:1). The primary end point is the composite events of all-cause death, heart failure events, and upgrade to biventricular pacing-delivered cardiac resynchronization therapy during at least 24 months of follow-up. Secondary end points include changes in echocardiographic, electrocardiographic, and pacing parameters and device-related complications.

CONCLUSIONS: The LEAP-Block study aims to compare the impact of left bundle-branch area pacing versus conventional right ventricular pacing in patients with atrioventricular block and preserved cardiac function with respect to midterm clinical outcomes. This trial will provide high-quality evidence for the selection of optimal pacing strategies in clinical practice.

REGISTRATION INFORMATION: clinicaltrials.gov. Identifier: NCT04730921.

PMID:43018069 | DOI:10.1161/JAHA.126.050375