Heart failure & cardiomyopathiesRandomised controlled trial
Conduction System vs Biventricular Pacing in Heart Failure
- Randomised controlled trial
- multicentre
- non-inferiority
- investigator-initiated
- 14 hospitals in Brazil
Authors' conclusion
In patients with HFrEF and LBBB, CSP was inferior to BiVP for a composite of death, HF hospitalizations, urgent HF visits, and change in LVEF at 12 months.
Study context
- Population
- Adults with symptomatic heart failure with reduced ejection fraction (HFrEF) (NYHA II–III), left ventricular ejection fraction (LVEF) ≤35% and left bundle-branch block (LBBB) (QRS ≥130 ms)
- Participants
- 173 adults
- Comparison
- Conduction system pacing (CSP) vs biventricular pacing (BiVP)
- Primary endpoint
- Hierarchical composite of:
- Death
- Heart failure (HF) hospitalizations
- Urgent HF visits
- Change in LVEF (non-inferiority margin OR 1.2)
- Follow-up
- 12 months
Primary result
As reported in the abstract
Odds ratio
2.36
95% CI 1.37–4.06
P = 0.002
CSP vs BiVP
OR 2.36 (95% CI 1.37–4.06); P = 0.002
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Time-to-event composite of death, HF hospitalizations or urgent HF visits | 2.35 (0.99–5.61) | |
| 0.20.5125Hazard ratio (log scale) |
Mean
| Outcome | CSP | BiVP | mean difference (95% CI) | |
|---|---|---|---|---|
| LVEF | 35% (SD 12%) | 39% (SD 12%) | 3.8% (0.3%–7.3%) | |
| −50510Difference (linear scale) |
| Outcome | difference (95% CI) |
|---|---|
| Total direct medical cost (procedure and HF care) · 12 months · lower with CSP | $7090 ($5779-$8648) |
QRS duration, KCCQ Overall Summary Score, NYHA class, natriuretic peptides
- Comparable improvements from baseline in both groups
Original publication
Conduction System vs Biventricular Pacing in Heart Failure. JAMA Cardiol. Published 1 April 2026. doi:10.1001/jamacardio.2026.0101
Summarised from the published abstract; every number is checked against it