RecruitingNot ApplicableNCT07250529

Left Bundle Branch Pacing vs Right Ventricular Pacing on AHRE Burden in Patients With Preserved LVEF

Comparison of Left Bundle Branch Pacing Versus Conventional Right Ventricular Pacing on AHRE Burden in Patients With Preserved Left Ventricular Ejection Fraction and High Ventricular Pacing Dependency (LBBP-AHRE Trial): A Randomized Study

Sponsor

University Hospital of Patras

Enrollment

244 participants

Start Date

Feb 5, 2026

Study Type

INTERVENTIONAL

Conditions

Atrial Fibrillation (AF)Atrioventricular Block Pacemaker Therapy Preserved Ejection Fraction

Summary

This prospective, randomized controlled trial aims to evaluate the effect of left bundle branch pacing (LBBP) compared with conventional right ventricular (RV) pacing on the cumulative duration (total time) of atrial high-rate episodes (AHREs) in patients with preserved left ventricular ejection fraction (LVEF) who are expected to require frequent ventricular pacing. Atrial High-Rate Episodes (AHREs) are defined as episodes of atrial tachyarrhythmia that are automatically recorded by device diagnostics and detected by implanted cardiac devices. These episodes usually have an atrial rate ≥170 beats per minute and a duration ≥6 minutes. AHREs are linked to a higher risk of thromboembolic events and clinical atrial fibrillation (AF), and they may indicate subclinical AF or other atrial tachyarrhythmias. Chronic RV pacing has been linked to mechanical and electrical dyssynchrony, which may encourage atrial remodeling and the development of AF. LBBP provides a more physiological ventricular activation and may reduce atrial tachyarrhythmia time (AHRE time). Patients with LVEF \>50% and atrioventricular (AV) conduction disorders requiring a dual-chamber pacemaker will be randomized to either conventional RV septal pacing or LBBP.

Eligibility

Min Age: 18 Years

Inclusion Criteria6

Age ≥ 18 years
Scheduled implantation of a dual-chamber pacemaker for:
Permanent complete heart block Permanent second-degree AV block (Mobitz II or Mobitz I)
Documented preserved LVEF (≥50%)
Sinus rhythm at baseline
Ability to provide written informed consent

Exclusion Criteria13

History of paroxysmal, persistent, or permanent atrial fibrillation
Previous atrial fibrillation ablation (catheter-based or surgical)
LVEF \< 50%
Sinus node disease
Transient AV block requiring pacemaker implantation
Significant structural or valvular heart disease
Requirement for pacemaker system upgrade during the study period
Requirement for antiarrhythmic therapy for causes other than atrial fibrillation
Existing pacemaker or other cardiac device requiring modification for study participation
Enrollment in another clinical trial that could interfere with study endpoints or pacing parameters
Contraindication to LBBP or associated lead implantation procedure
Life expectancy \< 12 months
Any condition judged by the investigator to compromise participation or the integrity of study data

Interventions

DEVICERight Ventricular Pacing

Implantation of a dual-chamber pacemaker with the ventricular lead placed in the RV septum. At follow-up, the ventricular pacing percentage and pacing configuration will be noted. All devices used in this study are commercially available in the European Union and carry a valid CE mark.

DEVICELeft Bundle Branch Pacing

Implantation of a dual-chamber pacemaker with the ventricular lead placed at the left bundle branch area. Physiological pacing will be programmed into the devices and, at follow-up, the percentage of spontaneous pacing will be noted. All devices used in this study are commercially available in the European Union and carry a valid CE mark.