Two-year outcomes of left bundle branch area pacing versus traditional right ventricular pacing in middle-aged adults: a registry-based trial

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Conflicts of Interest

Identified Weaknesses

Rating Explanation

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Paper Summary

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Left Bundle Branch Pacing Wins in Preventing Heart Failure for Middle-Aged Adults (Italian Edition)

In this Italian registry-based trial of adults under 65, pacing the left bundle branch area was better than traditional right ventricular pacing at reducing the combined risk of cardiovascular death and heart failure hospitalization over two years. However, no significant differences were seen in cardiovascular or all-cause mortality alone. Several authors disclosed financial ties to device manufacturers.

Possible Conflicts of Interest

Several authors disclosed receiving speaker or consultant fees from medical device companies involved in cardiac pacing, including Biotronik, Abbott, Boston Scientific, Microport, Medtronic, and Edwards Lifesciences.

Identified Weaknesses

Limited generalizability due to small subgroup sizes and a geographically restricted sample

The small number of patients with some conditions like slow atrial fibrillation or prior heart attacks made it hard to draw reliable conclusions about those subgroups. The study was also limited to Italian patients, so it's unclear if the findings would apply to other populations.

Non-randomized treatment allocation, introducing potential for selection bias

While the study used a registry and assigned treatments in a way designed to minimize bias, it wasn't a true randomized controlled trial, so it's harder to be sure the observed differences were solely due to the pacing method.

Lack of medication data and potential variability in device programming introduces confounding factors

The study didn't collect data on all medications patients were taking, which could influence heart outcomes and potentially create bias in the results. Also, doctors had flexibility in programming the devices, potentially affecting ventricular pacing percentages and outcomes.

Rating Explanation

This was a well-designed registry-based trial with a decent sample size. Although it wasn't a true RCT, efforts were made to minimize bias in treatment assignment and the analysis included relevant statistical adjustments. The findings are important for clinical practice, but the limitations regarding generalizability and potential confounding factors prevent a top rating.

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