Hospital Moinhos de Vento

Mixed Results from Cardiac Resynchronization Trials Challenge Left Bundle Branch Pacing as BiV Alternative

- Recent randomized controlled trials present conflicting evidence on left bundle branch area pacing (LBBAP) versus traditional biventricular pacing for cardiac resynchronization therapy, with operator experience emerging as a critical factor. - The LECART trial demonstrated superior outcomes with LBBAP, primarily driven by reduced device-related complications requiring surgical reintervention, while the LEFT-BUNDLE-CRT trial failed to establish noninferiority. - Extended follow-up data from multiple studies suggest that while conduction-system pacing shows promise, biventricular pacing remains the established first-line therapy with the strongest evidence base. - Expert consensus indicates the field is moving toward individualized CRT approaches based on anatomy, conduction patterns, and operator expertise rather than universal replacement of conventional therapy.