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.
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.
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.
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