OptimPacing
in atrioventricular block, left bundle branch pacing cuts death, heart failure hospitalisation or pacing-induced cardiomyopathy by 59 percent compared with conventional right ventricular pacing; the trial was stopped early
Presented in LBS.04 at AHA 2026 (Sunday 8 November) and published simultaneously in NEJM. OptimPacing is an investigator-initiated, open-label randomised trial at 17 centres in mainland China, Hong Kong, the United Kingdom, Poland and the United States (June 2021 to January 2025). Adults with second-degree or complete atrioventricular block, or persistent atrial fibrillation with a slow ventricular rate, and a mostly preserved ejection fraction were randomised 1:1 to left bundle branch pacing or right ventricular pacing (685 patients analysed, mean age 68.4, 57.5 percent men). Primary endpoint: all-cause death, heart failure hospitalisation or pacing-induced cardiomyopathy. At the planned interim analysis after a median of about three years the 4-year cumulative incidence was 8.5 versus 19.2 percent, a 59 percent relative risk reduction (per the AHA release; Healio reports the NEJM hazard ratio as 0.41, 95 percent CI 0.23 to 0.75, P = 0.003, 16 versus 35 events). Pacing-induced cardiomyopathy: 0 versus 11.7 percent; heart failure hospitalisation 1.5 versus 2.9 percent; all-cause death similar (7.4 versus 7.7 percent, Healio). The data monitoring committee recommended stopping the trial for superiority. Limitations: early termination, mostly preserved LVEF at baseline, a single lead type.
Join us
Join the Global Primary Care Cardio Network. Membership is free.
Would you like to tell us more about yourself?
Interests
We will send you an email with a link to confirm your registration.
