Arrhythmias & electrophysiology
Clinical Outcomes of Conduction System Pacing vs Right Ventricular Septal Pacing in Atrioventricular Block: The CSPACE Randomized Controlled Trial
Primary resultResult — go to the resultHazard ratio 0.35 95% CI 0.19–0.64Authors' conclusion
This RCT demonstrates the superiority of CSP over RVsP in achieving improved clinical outcomes
Study context
- Population
- Consecutive patients with pacing indication for atrioventricular (AV) block without cardiac resynchronization therapy (CRT) indication
- Participants
- 202 patients
- Comparison
- Conduction system pacing (CSP) vs right ventricular (RV) septal pacing
- CSPn = 101
- Primary endpoint
- Composite of:
- Pacing-induced cardiomyopathy (PICM)
- Upgrade to biventricular CRT
- HF hospitalization
- All-cause mortality
- Follow-up
- Mean 25.2 ± 11.8 months
Methodological details1:1 randomization
- 1:1 randomization
Primary result
As reported in the abstract
Hazard ratio
0.35
95% CI 0.19–0.64
P < 0.001
By group
CSP vs RVsP
HR 0.35 (95% CI 0.19–0.64); P < 0.001
Further findings
| Outcome | CSP | RVsP | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| PICM | 4.58 events per 100-person-years | 14.69 events per 100-person-years | 0.31 (0.15–0.67) | P = 0.002 | |
| HF hospitalization | 0.48 events per 100-person years | 2.92 events per 100-person years | 0.16 (0.02–1.37) | P = 0.057 | |
| All-cause mortality | 2.86 events per 100-person-years | 4.72 events per 100-person-years | 0.61 (0.22–1.69) | P = 0.337 | |
| 0.050.21520Hazard ratio (log scale) |
CRT upgrade
HR 1.65e-9 (0-∞) · P = 0.043
- CSP procedural success
- 88.1% · 89 of 101
- CSP procedural success: 89 of 101
Safety
Lead revision
P = 0.017
Original publication
Clinical Outcomes of Conduction System Pacing vs Right Ventricular Septal Pacing in Atrioventricular Block: The CSPACE Randomized Controlled Trial. J Am Coll Cardiol. Published 26 August 2025. doi:10.
Summarised from the published abstract; every number is checked against it