Clinically, LBBAP was associated with lower heart failure hospitalization (RR 0.38, 95% CI 0.29-0.52; p < 0.0001) and reduced all-cause mortality (RR 0.55, 95% CI 0.41-0.72; p < 0.0001), along with greater reduction in NT-proBNP levels.<h4>Conclusion</h4>LBBAP provides superior electrical synchrony, improved cardiac remodeling, and favorable clinical outcomes compared with RVP, while maintaining a comparable procedural safety profile. This evidence concerns the gene NPPB and heart failure.