Heart failure & cardiomyopathies
His Pacing vs Biventricular Pacing for Cardiac Resynchronization Therapy: Long-Term Follow-Up From the His-Alternative I Trial
Authors' conclusion
No statistically significant difference in long-term performance was detected between His-CRT with low implantation thresholds and BiV-CRT, and echocardiographic response was comparable.
Study context
- Population
- Patients with symptomatic heart failure (HF), left ventricular ejection fraction ≤35%, and left bundle branch blockrandomized, following crossover at implantation, 19 received His-CRT and 31 received BiV-CRT · His-CRT 19 · BiV-CRT 31
- Participants
- 50 patients
- Comparison
- His-CRT vs BiV-CRT
- His-CRTn = 19
- BiV-CRTn = 31
Methodological detailsfirst randomized European trial, crossover at implantation, primary analyses by treatment received
- First randomized European trial
- Crossover at implantation
- Primary analyses by treatment received
Primary result
As reported in the abstract
Lead revisions · median follow-up 5.3 years (Q1-Q3: 4.6-5.7 years)
P = 0.003
Further findings
Generator replacements · median follow-up 5.3 years (Q1-Q3: 4.6-5.7 years) · more with His-CRT
P = 0.005
Echocardiographic response (≥15% reduction in left ventricular end-systolic volume compared with baseline) · comparable
P = 1.0
Reinterventions and threshold development over time, His-CRT with implantation thresholds ≤2.5 V/1 millisecond vs BiV-CRT
- No statistically significant differences
All-cause mortality or hospitalization for HF
- HR between groups (similar risk; comparator not stated)
- HR: 0.32; 95% CI: 0.07-1.49; P = 0.147
Original publication
His Pacing vs Biventricular Pacing for Cardiac Resynchronization Therapy: Long-Term Follow-Up From the His-Alternative I Trial. JACC Clin Electrophysiol. Published 13 April 2026. doi:10.
Summarised from the published abstract; every number is checked against it