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Fixed AV delay after LBBAP for sinus node dysfunction: left atrial volume change at 12 monthsNew Strategy for Managing Heart Rhythm After LBBAP Procedure

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Key Takeaway
Note: This is a trial protocol; no results are available to guide practice.

This prospective, single-center, randomized, open-label trial with blinded endpoint assessment (PROBE design) enrolled 216 patients with sinus node dysfunction who underwent successful left bundle branch area pacing (LBBAP). Patients were randomized to a fixed optimized AV delay strategy (paced AV 150 ms; sensed AV 120 ms; minimal ventricular pacing algorithms disabled) or a minimal ventricular pacing strategy using device-specific algorithms (paced AV 200 ms; sensed AV 150 ms). The primary outcome is change in left atrial volume from baseline to 12 months. Secondary outcomes include device-detected atrial high-rate episodes and atrial fibrillation burden. Follow-up duration is 12 months. No results are reported in this protocol description; the study is ongoing. Safety data, adverse events, and tolerability are not reported. The open-label design is a limitation. The trial aims to determine whether active optimization of AV synchrony after LBBAP is noninferior to conventional minimal ventricular pacing in preventing left atrial remodeling and reducing atrial arrhythmia burden. Clinicians should await results before applying these strategies.

This study looked at how different pacing methods affect the heart after a procedure called left bundle branch area pacing (LBBAP). The researchers focused on patients with sinus node dysfunction who had already undergone this specific surgery.

The trial compared two different ways of setting the device. One method used a fixed, optimized timing for the heart's electrical signals. The other used standard, automatic settings. The goal was to see if the custom timing could prevent the left atrium from changing size and reduce instances of atrial fibrillation.

Because this study is currently a trial design description, no final results have been reported yet. It is important to note that because it is an open-label design, researchers were aware of which patients received which treatment. Patients should talk to their doctors about the best pacing strategy for their specific heart condition.

What this means for you:
A new trial is testing if custom pacing timing can prevent heart changes after LBBAP surgery.

Common questions

What is the goal of this new pacing strategy?

The goal is to see if a fixed, optimized AV delay strategy can be just as effective as standard settings. Specifically, researchers want to know if it prevents the left atrium from changing size and reduces the burden of atrial fibrillation in patients with sinus node dysfunction.

Who is this study for?

This trial specifically involves 216 patients who have sinus node dysfunction and have already had a successful LBBAP implantation. It focuses on how these specific patients respond to different pacing settings over a period of 12 months.

Are there any known side effects from this new method?

Because this is a trial design description and not a report of completed results, no safety data or adverse events have been reported yet. You should consult your cardiologist to discuss the safest options for your specific heart condition.

Study Details

Study typeRct
Sample sizen = 216
EvidenceLevel 2
Follow-up12.0 mo
PublishedJun 2026
View Original Abstract ↓
Left bundle branch area pacing (LBBAP) is a physiological pacing modality that preserves ventricular synchrony. In patients with sinus node dysfunction, who frequently exhibit delayed intrinsic atrioventricular conduction, the optimal postimplant programming strategy remains uncertain. Minimal ventricular pacing algorithms prioritize intrinsic conduction but may permit nonphysiological atrioventricular (AV) prolongation, potentially contributing to left atrial remodeling and atrial tachyarrhythmias. This is a prospective, single-center, randomized, open-label trial with blinded endpoint assessment (PROBE design). A total of 216 patients with sinus node dysfunction and successful LBBAP implantation will be randomized 1:1 to either a fixed optimized AV delay strategy (paced AV 150 ms; sensed AV 120 ms; minimal ventricular pacing algorithms disabled) or a minimal ventricular pacing strategy using device-specific algorithms (paced AV 200 ms; sensed AV 150 ms). The primary endpoint is the change in left atrial volume from baseline to 12 months, evaluated in a noninferiority comparison. Secondary endpoints include device-detected atrial high-rate episodes and atrial fibrillation burden (AF burden). In conclusion, this trial is designed to determine whether active optimization of AV synchrony after LBBAP implantation is noninferior to a conventional minimal ventricular pacing strategy in preventing left atrial remodeling and whether it may reduce atrial arrhythmia burden.
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