The CONDUCT-AF trial: Rationale and design of a prospective, randomized, multicentre study comparing conduction
Maja Ivanovski1,2, Miha Mrak1, Anja Zupan Mežnar1
1Cardiology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Insights
The CONDUCT-AF trial compares conduction system pacing (CSP) to biventricular pacing (BVP) in heart failure patients with atrial fibrillation. It aims to determine if CSP is a viable alternative to BVP for improving cardiac function.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Symptomatic refractory atrial fibrillation (AF) in heart failure (HF) patients with reduced ejection fraction often requires atrioventricular node ablation (AVNA).
- Optimal pacing strategies post-AVNA remain debated, with limited randomized data comparing conduction system pacing (CSP) and biventricular pacing (BVP).
Purpose of the Study:
- To investigate the non-inferiority of CSP compared to BVP in improving left ventricular ejection fraction (LVEF) and clinical outcomes.
- To evaluate CSP as an alternative pacing modality in patients with HF and symptomatic AF undergoing AVNA.
Main Methods:
- A prospective, randomized, multicenter clinical trial (CONDUCT-AF) enrolling 82 patients with symptomatic AF, HF with reduced LVEF, and narrow QRS.
- Patients randomized 1:1 to CSP or BVP, followed by AVNA and a minimum 24-month follow-up.
- Primary endpoint: change in LVEF at 6 months; secondary endpoints include HF events, quality of life, and biomarkers.
Main Results:
- Primary endpoint data (change in LVEF at 6 months) are pending.
- Secondary endpoint data collection is ongoing, including heart failure hospitalizations and cardiovascular mortality.
Conclusions:
- The CONDUCT-AF trial is expected to provide crucial evidence on the efficacy and safety of CSP versus BVP in this patient population.
- Study recruitment is concluding in 2025, with anticipated results in 2026, informing future pacing strategies.
Aims:
There is a lack of data from randomized clinical trials comparing treatment outcomes between conduction system pacing (CSP) modalities and biventricular pacing (BVP) in symptomatic patients with refractory atrial fibrillation (AF) scheduled for atrioventricular node ablation (AVNA). The CONDUCT-AF investigates whether CSP is non-inferior to BVP in improving left ventricular ejection fraction (LVEF) and clinical outcomes in heart failure (HF) patients with symptomatic AF undergoing AVNA.
Methods:
This study is an investigator-initiated, prospective, randomized, multicentre clinical trial conducted across 10 European centres, enrolling 82 patients with symptomatic AF, HF with reduced LVEF, and narrow QRS. Participants will be randomized 1:1 to CSP or BVP with subsequent AVNA and followed for at least 24 months. The primary endpoint is the change in LVEF after 6 months. Secondary endpoints will include time to the first occurrence of worsening HF or cardiovascular death and its individual components, total number of HF hospitalizations, change in quality of life, N-terminal pro-B-type natriuretic peptide, 6-min walk test distance, and safety outcomes.
Conclusions:
The CONDUCT-AF trial will provide critical insights into the optimal pacing modality for patients with HF and refractory AF undergoing AVNA. Recruitment is expected to conclude in 2025, with the first study results anticipated in 2026.
