New Clinical Data Shows Left Bundle Branch Area Pacing Reduces Re-Intervention Risk in Heart Failure Patients

The LECART trial finds that left bundle branch area pacing is safer and faster than standard biventricular pacing for heart failure patients.

By: AXL Media

Published: Apr 14, 2026, 7:54 AM EDT

Source: Information for this report was sourced from EurekAlert

Advancing Cardiac Resynchronization Therapy

Cardiac resynchronization therapy, or CRT, is a vital intervention for heart failure patients whose heart chambers do not beat in unison. By implanting a pacemaker, clinicians can restore electrical synchrony, particularly in those with a reduced left ventricular ejection fraction and a specific conduction defect known as left bundle branch block. While standard biventricular pacing has long been the clinical norm, experts estimate that up to one-third of patients fail to respond to the treatment. This limitation has driven the medical community to investigate more physiological approaches to restore the heart's natural rhythm.

The LECART Trial Framework

Presented at the European Heart Rhythm Association annual congress in Paris, the LECART trial is the first head-to-head randomized study to compare biventricular pacing with left bundle branch area pacing, or LBBAP. Conducted across 11 high-volume medical centers in Belgium, the prospective study enrolled 168 patients with a mean age of 69 years. Participants were required to have heart failure categorized as NYHA functional class II to IV and an ejection fraction below 40 percent. The study uniquely focused on composite endpoints that included death, hospitalization, and, most importantly, device-related complications that require surgical re-intervention.

Significant Reduction in Surgical Complications

The findings revealed a stark difference in safety profiles between the two pacing methods over a one-year period. In the biventricular pacing group, 25 percent of patients reached the primary composite outcome, compared to only 13 percent in the LBBAP group. According to Professor Jean-Benoît le Polain de Waroux of AZ Sint-Jan Hospital, this disparity was primarily fueled by a significantly higher rate of complications requiring secondary surgery. Specifically, 15 percent of biventricular pacing patients required re-intervention, whereas only 1 percent of those receiving the newer LBBAP method faced similar surgical revisions.