New data on effective cardiac resynchronisation in patients with heart failure

Key takeaways

• Cardiac resynchronisation therapy (CRT) involves the implantation of a pacemaker in patients with heart failure and a conduction defect to help the chambers of their heart beat in time.
• The LECART study compared CRT using standard biventricular pacing with a newer method, left bundle branch area pacing (LBBAP).
• LBBAP was found to be an effective and practical strategy, which was associated with fewer device-related complications, thereby reducing the need for patients to have another operation.

Paris, France - 14 April 2026: Left bundle branch area pacing was found to be an effective and practical strategy for cardiac resynchronisation, according to a Late-Breaking Science presentation at EHRA 2026,[1] the annual congress of the European Heart Rhythm Association (EHRA), a branch of the European Society of Cardiology (ESC).

Cardiac resynchronisation therapy (CRT) involves implanting a pacemaker device to help the chambers of the heart pump simultaneously. CRT is used in certain patients with heart failure who remain symptomatic despite guideline-recommended medical therapy and have electrical dyssynchrony. Specifically, it is a treatment option for patients with heart failure and reduced left ventricular ejection fraction (LVEF) who exhibit a dyssynchronous ECG pattern called 'left bundle branch block'.

"CRT with biventricular pacing is a well-established standard approach but up to one-third of patients do not respond,[2]" explained study presenter, Professor Jean-Benoît le Polain de Waroux from AZ Sint-Jan Hospital, Bruges, Belgium. He continued: "Left bundle branch area pacing (LBBAP) has emerged as a more physiological approach to restore synchrony; however, there is a lack of data from head-to-head randomised trials. The LECART trial was designed to compare LBBAP with biventricular pacing and uniquely incorporated the clinically meaningful endpoints of device-related complications requiring surgical re-interventions and failure to deliver resynchronisation."

The prospective, randomised LECART trial was conducted at 11 high-volume centres in Belgium. Patients were eligible for inclusion if they had heart failure of NYHA functional class II−IV, LVEF <40%, left bundle branch block and an indication for CRT according to current ESC Guidelines. Patients were randomised 1:1 to LBBAP or biventricular pacing. The primary outcome, assessed over the first year, was a four-component composite: death from any cause, heart failure hospitalisation, any device-related complication requiring a surgical re-intervention or failure to deliver efficiently the assigned resynchronisation therapy. All events were reviewed by an independent blinded adjudication committee.

The 168 randomised patients had a mean age of 69 years, with 33% being female. Most patients (67%) had NYHA class II heart failure and 77.5% were receiving at least three out of the four ESC Guidelines-recommended pillars of heart failure medication.

Over the first year after device implantation, the incidence of the primary outcome was 25% in the biventricular pacing group and 13% in the LBBAP group (hazard ratio 2.14; 95% confidence interval [CI] 1.01 to 4.51; p=0.039). This difference was predominantly driven by a higher incidence of device-related complications with biventricular pacing vs. LBBAP (15% vs. 1%; odds ratio 6.76; 95% CI 1.48 to 31.25; p=0.006), with no significant difference observed for death, heart failure hospitalisation and implant failure.

Procedure time was significantly longer with biventricular pacing vs. LBBAP (90 minutes vs. 76 minutes; p=0.005), with similar functional improvement in both groups.

Professor le Polain de Waroux concluded: "This is the first randomised trial to demonstrate that LBBAP provides effective cardiac synchronisation while decreasing the need for surgical re-intervention. The reduction in complications plus shorter procedure times with LBBAP are important both for patients and for the healthcare system as a whole."

ENDS