20.500.12556/DiRROS-28888 Left bundle branch area pacing vs right ventricular pacing for atrioventricular block the MELOS RELOADED study Background and Aims: Left bundle branch area pacing (LBBAP) promotes physiological synchronous activation of the left ventricle and may be particularly beneficial in patients with atrioventricular block (AVB), but its mortality benefit remains unclear. This study aims to compare long-term survival in AVB patients receiving either LBBAP or right ventricular pacing (RVP) and to analyse predictors of mortality during LBBAP. Methods: MELOS RELOADED, a multicentre European collaboration, was a registry-based study of pacemaker patients with AVB, left ventricular ejection fraction (LVEF) >40% and ventricular pacing >20%. The primary outcome was all-cause mortality based on national registries. A 1:1 propensity score matching was performed between the RVP and LBBAP groups. Kaplan–Meier curves and multivariable Cox proportional hazards models were used to estimate survival. Results: In total, 3382 patients receiving LBBAP or RVP were matched. At 4-year follow-up, the Kaplan–Meier curve showed an absolute difference in survival of 11.8% in favour of LBBAP (P < .001). LBBAP was a robust predictor of reduced mortality with a hazard ratio (HR) of 0.53 (95% confidence interval 0.42–0.65, P < .001). Within the LBBAP group, the following independent predictors of increased mortality were identified: lack of confirmed left bundle branch capture (HR 1.85, P < .001), lower percentage of ventricular pacing (HR 1.12), and age. Conclusions: This is the first large study demonstrating the long-term survival benefit of LBBAP. This strengthens the use of LBBAP in AVB patients with preserved/mildly reduced LVEF while awaiting the results of randomized trials. Confirmation of left bundle branch capture seems advisable to achieve optimal results with LBBAP. conduction system pacing left bundle branch area pacing atrioventricular block mortality heart failure true false true Angleški jezik Ni določen Neznano 2026-04-10 15:02:38 2026-04-10 15:02:38 2026-04-11 03:54:50 0000-00-00 00:00:00 2026 0 0 Nasl. z nasl. zaslona; Opis vira z dne 26. 11. 2025; str. 1541–1550 issue 13 Vol. 47 2026 0000-00-00 Zaloznikova Objavljeno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 616.1 1522-9645 10.1093/eurheartj/ehaf699 258710019 RAZ_Jastrzębski_Marek_2026.pdf RAZ_Jastrzębski_Marek_2026.pdf 1 2494A378888D88D70FF4BAC43942CB50 5cd3b078c139dd92c62ca98aa4fa76c2815b96ebe34db9abaaa060426834bdbc ac72b31b-34dd-11f1-b941-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=43073 https://academic.oup.com/eurheartj/article/47/13/1541/8260797 1 8e6970a3-34dd-11f1-b941-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=43072 Univerzitetni klinični center Ljubljana 0 0 0