Heart failure & cardiomyopathies

Direct His/LBB pacing as an alternative to biventricular pacing in patients with HFrEF and a typical left bundle branch block (LBBB): Design and rationale for the His-Alternative II trial

Am Heart JPublished investigator-initiated, multicenter, randomized non-inferiority trial

Study context

Population
Patients with symptomatic heart failure (New York Heart Association class II to III), left ventricular ejection fraction ≤35%, strict LBBB by electrocardiographic criteria, and optimal medical therapypatients randomized
Participants
150 patients
Planned comparison
BiV-CRT vs conduction system pacing (CSP)-based cardiac resynchronization therapy (CRT)
Primary endpoint
Change in left ventricular end-systolic volume assessed by echocardiography
Follow-up
6 months
Methodological details1:2 randomization ratio, design and rationale
  • 1:2 randomization ratio
  • Design and rationale

No results yet. This paper sets out the design of a trial; its results are to come.

Original publication

Direct His/LBB pacing as an alternative to biventricular pacing in patients with HFrEF and a typical LBBB: Design and rationale for the His-Alternative II trial. Am Heart J. Published 20 May 2026. doi:10.1016/j.ahj.2026.107491

Summarised from the published abstract; every number is checked against it

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