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Updated: Sep 10, 2025

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Conduction system pacing vs. biventricular pacing for cardiac resynchronization: the CSP-SYNC randomized single

David Žižek1,2, Tadej Žlahtič1,2, Miha Mrak1

  • 1Cardiology Department, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|August 23, 2025
PubMed
Summary

Left bundle branch area pacing (LBBAP) is as effective as biventricular (BiV) pacing for cardiac resynchronization therapy (CRT). This study found LBBAP noninferior to BiV pacing in improving heart function and remodeling.

Keywords:
Biventricular pacingCardiac resynchronization therapyConduction system pacingLeft bundle branch area pacingLeft bundle branch block

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Pacing

Background:

  • Limited prospective randomized studies exist comparing LBBAP and BiV pacing for CRT.
  • This study addresses the need for comparative data in CRT patients.

Purpose of the Study:

  • To test if LBBAP is noninferior to BiV pacing in patients with a Class I indication for CRT.
  • To evaluate the efficacy of LBBAP as an alternative CRT strategy.

Main Methods:

  • Investigator-initiated, randomized, single-center CSP-SYNC study.
  • 62 patients randomized 1:1 to LBBAP or BiV pacing.
  • Primary endpoint: change in left ventricular ejection fraction (LVEF) at 6 months.

Main Results:

  • LBBAP demonstrated noninferiority to BiV pacing for LVEF improvement (14.0% vs 8.5%, P<0.001).
  • Both pacing methods showed comparable reductions in LVESV, improvements in 6-minute walk test, and NYHA class.
  • Similar trends in LV remodeling and heart failure hospitalization rates were observed.

Conclusions:

  • LBBAP is a noninferior alternative to BiV pacing for CRT in patients with Class I indication.
  • LBBAP achieves similar improvements in LVEF, structural, and electrical remodeling compared to BiV pacing.