A different pacemaker spot cut heart rhythm treatment problems in a trial

If you or someone you love has a pacemaker, or may need one, here is good news. Where the wire goes can make a real difference for the heart over time. In a new trial, a newer placement for heart rhythm treatment led to far fewer serious problems than the standard one.

The newer approach is called left bundle-branch area pacing. Over two years, about 2 in 100 people who got it had a death, a heart failure event or a pacemaker upgrade. With the standard placement, it was about 12 in 100.

How the study worked

Researchers at 14 hospitals in China randomly assigned 499 adults with heart block to one of two pacemaker placements and followed them for 24 months. Heart block means the electrical signal does not pass well from the upper to the lower chambers of the heart. Everyone in the study had normal heart pumping and was expected to need pacing much of the time. The analysis covered 482 people, with an average age of 67, and 46% were women. The trial was run in China only, so it will be useful to see it repeated elsewhere. It was published Oct. 28, 2026, in JAMA.

What is left bundle-branch area pacing?

Your heart has its own natural wiring that spreads the electrical signal fast, so both sides squeeze together. For decades, the standard was to place the pacemaker wire in the right lower chamber. That works, but it makes the heart contract in a less natural order. Over time, some people develop heart failure.

The newer method places the wire deep in the wall between the lower chambers. There it taps into the heart’s own wiring and keeps the beat closer to natural.

What they found

At 24 months, the main problem rate was 2.4% with the newer placement and 12.5% with the standard one. The main problem was a combination of death, a heart failure event, or an upgrade to a more advanced pacemaker.

The gap was largest for heart failure events: 3.4% with the newer placement versus 11.3% with the standard one. In plain terms, far fewer people ended up with heart failure.

The benefit showed up across all the groups the researchers checked. The procedure also worked about as well either way: 97.9% of the newer placements succeeded, compared with 99.6% of the standard ones. Rates of device complications were similar in both groups. There was no significant difference in deaths on their own, and the advantage came mainly from fewer heart failure events.

What you can do today

If you or a family member has a pacemaker, find the device card and take a photo of it with your phone. Add the date of your next check-up to the photo’s note or your calendar. If a pacemaker is ahead for you, you can ask the cardiologist where they plan to place the wire and why. This newer method takes specific training, so availability can vary from one hospital to another.