ClinicalEVIDENCE Newsletter

Summary

This issue of Clinical Evidence highlights key findings presented at EHRA Congress 2026. We begin with two Late-Breaking Clinical Trials evaluating left bundle branch area pacing (LBBAP) versus conventional biventricular pacing in patients requiring cardiac resynchronisation therapy (CRT). While both studies contribute important evidence, their differing results underscore the need for further investigation into the role of conduction system pacing.

​We then review two real-world analyses focused on the LUX-Dx™ Insertable Cardiac Monitor (ICM). These studies demonstrate high diagnostic accuracy, reduced false-positive transmission burden through remote reprogramming, and strong patient acceptance of smartphone-based remote monitoring.

Finally, we examine new S-ICD data from the RHYTHM DETECT registry supporting the safety and effectiveness of extrathoracic ICD therapy in complex patient populations, including patients with prior sternotomy and those with a history of monomorphic ventricular tachycardia. We conclude with breaking results from the PRAETORIAN-DFT trial, evaluating implantation strategies with and without defibrillation testing.

Key Takeaways

• Ongoing Evidence for LBBAP versus Conventional CRT: Two randomized trials presented at EHRA 2026 reported differing findings regarding the role of LBBAP as an alternative CRT delivery strategy. While LECART demonstrated procedural and clinical advantages, LEFT-BUNDLE-CRT did not establish non-inferiority in the intention-to-treat analysis, highlighting the need for additional randomized evidence.^{1, 2}
• Real-World Validation of LUX-Dx Performance: New evidence confirms high diagnostic accuracy of the LUX-Dx ICM in routine clinical practice. Remote reprogramming reduced false-positive transmission burden, while the myLUX™ Patient App demonstrated strong usability and patient acceptance across diverse patient populations.^{3, 4}
• New Evidence Supporting S-ICD Therapy: Recent registry analyses showed that prior sternotomy does not adversely affect S-ICD implantation or performance and that patients with prior monomorphic ventricular tachycardia can achieve effective protection from ventricular arrhythmias without requiring conversion to a transvenous ICD system.^{5, 6}
• PRAETORIAN-DFT Trial Breaking News: New randomized evidence suggests that omission of ventricular fibrillation conversion testing during de novo S-ICD implantation may be non-inferior to standard testing when guided by the PRAETORIAN score, potentially simplifying implantation workflows. ⁷