Arrhythmias & electrophysiology
Prospective randomized trial of conduction system pacing vs right ventricular pacing for patients with atrioventricular block; Prague conduction system pacing (CSP) trial
Authors' conclusion
In patients with severe conduction disease, CSP led to a smaller LVEF decline than RVP after 1 year of pacing. Both pacing methods had similar rates of clinical end points and procedural complications.
Study context
- Population
- Patients with pacemaker indication due to atrioventricular conduction disease
- Participants
- 249 patients
- Comparison
- CSP vs right ventricular pacing (RVP)
- CSPn = 124
- RVPn = 125reference
- Primary endpoint
- Change in LVEF
- Follow-up
- 12 months
Methodological detailsIn CSP, 10 received His bundle pacing, 96 left bundle branch area pacing, 15 deep septal pacing and 3 RVP
- In CSP, 10 received His bundle pacing, 96 left bundle branch area pacing, 15 deep septal pacing and 3 RVP
Primary result
As reported in the abstract
CSP
−2%
RVP
−4%
P = 0.03
Further findings
LVEF decrease ≥ 10% · intention-to-treat analysis
P = 0.01
| Outcome | CSP | RVP | P value |
|---|---|---|---|
| Composite of CV death, CRT upgrade or HF hospitalisationNo difference | 4 events | 9 events | P = 0.15 |
| Procedural and fluoroscopy timesLonger with CSP | P < 0.001 | ||
| Procedural time | 63 minutes | 40 minutes | |
| Fluoroscopy time | 7 minutes | 3 minutes |
Safety
Events
| Outcome | CSP | RVP | P value |
|---|---|---|---|
| Procedural complicationsNo difference | 2 | 9 | P = 0.09 |
Original publication
Prospective randomized trial of conduction system pacing vs right ventricular pacing for patients with atrioventricular block; Prague CSP trial. Heart Rhythm. Published 22 May 2025. doi:10.
Summarised from the published abstract; every number is checked against it