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LECART Trial Reports Lower Complication Rate with Left Bundle Branch Area Pacing in Cardiac Resynchronization Therapy

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New Pacing Technique Shows Fewer Complications in Heart Failure Treatment

A randomized clinical trial presented at a major cardiology conference found that a newer pacing technique resulted in fewer device-related complications requiring repeat surgery compared to a standard method for cardiac resynchronization therapy. The study reported similar functional improvements for patients with both approaches.

Study Presentation and Design

The results of the LECART trial were presented at EHRA 2026, the annual congress of the European Heart Rhythm Association.

The prospective, randomized trial was conducted at 11 centers in Belgium. It enrolled 168 patients with heart failure, a reduced left ventricular ejection fraction (below 40%), and left bundle branch block. All patients had an indication for cardiac resynchronization therapy (CRT) according to European Society of Cardiology guidelines.

Participants were randomly assigned in a 1:1 ratio to receive one of two pacing strategies:

  • Left bundle branch area pacing (LBBAP)
  • Standard biventricular pacing

An independent, blinded adjudication committee reviewed all trial events.

Reported Outcomes

The primary outcome was a composite of death from any cause, hospitalization for heart failure, device-related complications requiring surgical re-intervention, or failure to deliver resynchronization therapy.

The difference was primarily attributed to device-related complications requiring surgical re-intervention, which occurred in 1% of the LBBAP group and 15% of the biventricular pacing group.

Primary Outcome and Complications:

  • Over the first year, the incidence of the primary composite outcome was 13% in the LBBAP group and 25% in the biventricular pacing group.
  • The reported hazard ratio was 2.14 (95% confidence interval 1.01 to 4.51).
  • The odds ratio for complications requiring surgery was 6.76 (95% CI 1.48 to 31.25).

Other Measures:

  • No significant difference was observed between the two groups for the individual components of death, heart failure hospitalization, or implant failure.
  • The average procedure time was 76 minutes for LBBAP and 90 minutes for biventricular pacing.
  • Functional improvement was reported to be similar in both groups.

Background on Cardiac Resynchronization Therapy

Cardiac resynchronization therapy involves implanting a pacemaker to coordinate the pumping of the heart's chambers. It is a treatment for certain patients with heart failure who remain symptomatic despite medication and have electrical dyssynchrony.

  • Biventricular pacing is a standard approach for CRT, but an estimated one-third of patients do not respond to this therapy.
  • Left bundle branch area pacing has been proposed as a more physiological alternative. Prior to the LECART trial, data from head-to-head randomized comparisons of the two techniques were lacking.

Researcher Statement

"This is the first randomized trial to demonstrate that LBBAP provides effective cardiac synchronization while decreasing the need for surgical re-intervention."

Professor Jean-Benoît le Polain de Waroux, the study presenter from AZ Sint-Jan Hospital in Bruges, Belgium, provided a statement on the findings. He noted the reduction in complications and shorter procedure times are important for patients and healthcare systems.