Direct His/LBB pacing as an alternative to biventricular pacing in patients with HFrEF and a typical LBBB: Design and rationale for the His-Alternative II trial.
Am Heart JMay 20, 2026 (epub)
Clinical ResearchCardiology
Niels Risum, Berit Thornvig Philbert, Jesper Hastrup Svendsen et al.
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In 30 seconds
The His-Alternative II trial is a multicenter, randomized non-inferiority study comparing conduction system pacing (CSP) to biventricular pacing (BiV-CRT) in patients with heart failure and left bundle branch block. The trial enrolled 150 patients to assess changes in left ventricular end-systolic volume over 6 months, aiming to determine if CSP can achieve similar remodeling effects as BiV-CRT.
Key findings
- 150 patients were randomized in a 1:2 ratio to receive BiV-CRT or CSP-based CRT.
- The primary endpoint is change in left ventricular end-systolic volume assessed by echocardiography.
- Secondary endpoints include functional capacity, symptomatic status, and quality of life.
Why it matters
This study addresses the need for effective alternatives to biventricular pacing in heart failure patients who may not respond optimally to conventional therapies, potentially improving patient outcomes in this population.