Left bundle-branch pacing reduced the risk of death, heart failure hospitalization, or pacing-induced cardiomyopathy by 59 percent compared to traditional right ventricular pacing in patients with atrioventricular block, according to clinical trial results presented at the American Heart Association scientific sessions and published in the New England Journal of Medicine.
OptimPacing Trial Results
Researchers tracked nearly 700 men and women diagnosed with atrioventricular block who required a pacemaker over a five-year period. The mean patient age was 68 years, and roughly 58 percent of the participants were men. Patients were randomly assigned to receive either left bundle-branch pacing or conventional right ventricular pacing.
Over a median follow-up period of 35 months, a primary outcome event occurred in 16 patients, amounting to 8.5 percent, in the left bundle-branch pacing group.
By comparison, 35 patients, or 19.2 percent, experienced a primary outcome event in the right ventricular pacing group. The lower incidence was primarily driven by reductions in heart failure hospitalizations and pacing-induced cardiomyopathy.
No participants in the left bundle-branch pacing group developed pacing-induced cardiomyopathy.
Meanwhile, 11.7 percent of patients in the right ventricular pacing group developed the condition. Heart failure hospitalization occurred in 1.5 percent of the left bundle-branch pacing group versus 2.9 percent of the right ventricular pacing group.
Early Trial Termination
The stark contrast in patient outcomes prompted an independent data monitoring committee to recommend ending the international, multicenter study early.
“We expected that the group with left bundle branch pacing would do better than the group with right ventricular pacing,” said Jiangang Zou, MD, PhD.
“However, the difference between the two groups was greater than we expected. This study shows that left bundle branch pacing should be the first choice for patients with heart block who need a pacemaker.”
Questions About the OptimPacing Trial Participants and Results
Who participated in the OptimPacing trial?
The international trial evaluated nearly 700 men and women with a mean age of 68 years who had atrioventricular block and required treatment with an artificial pacemaker.
Why did the monitoring committee stop the study early?
The independent data monitoring committee recommended halting the trial early because left bundle-branch pacing demonstrated a 59 percent lower risk of death, heart failure hospitalization, or cardiomyopathy than right ventricular pacing.
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