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Randomized Controlled Trial
. 2025 Oct;22(10):e894-e902.
doi: 10.1016/j.hrthm.2025.05.036. Epub 2025 May 22.

Prospective randomized trial of conduction system pacing vs right ventricular pacing for patients with atrioventricular block; Prague CSP trial

Karol Curila  1 , Jan Mizner  2 , Jan Morava  3 , Radovan Smisek  4 , Jana Vesela  2 , Ondrej Sussenbek  2 , Petr Stros  2 , Jindrich Kupec  3 , Petr Waldauf  5 , Pavel Leinveber  6 , Lukas Poviser  2 , Laszlo Nagy  7 , Jan Cerny  3 , Barbora Bitmanova  3 , Pavel Jurak  4 , Rostislav Polasek  3
Affiliations
Randomized Controlled Trial

Prospective randomized trial of conduction system pacing vs right ventricular pacing for patients with atrioventricular block; Prague CSP trial

Karol Curila et al. Heart Rhythm. 2025 Oct.

Abstract

Background: Conduction system pacing (CSP) replaces right ventricular pacing (RVP) in bradycardia patients.

Objective: To compare CSP vs RVP in patients with pacemaker indication due to atrioventricular conduction disease.

Methods: This study randomized patients to CSP or RVP in 1:1 ratio and followed them for 12 months. CSP received either His bundle pacing or left bundle branch area pacing; The primary end point was a change in the left ventricular ejection fraction (LVEF). The combined composite clinical end point consisted of cardiovascular death, cardiac resynchronization therapy upgrade, or hospitalization for heart failure.

Results: Of 249 patients, 125 were randomized to RVP and 124 to CSP; there were no differences between clinical parameters. In CSP, 10 patients received His bundle pacing, 96 left bundle branch area pacing, 15 deep septal pacing, and 3 RVP. Procedural and fluoroscopy times were longer in CSP vs RVP (63 vs 40 and 7 vs 3 minutes; P < .001). In the intention-to-treat analysis, the LVEF decline in CSP was smaller than RVP (-2% vs -4%, P = .03), and a LVEF decrease ≥ 10% occurred more often in RVP 19 (16%) than CSP 6 (5%), P = .01. There was no difference in the composite clinical outcome between RVP and CSP (9 vs 4, P = .15). There was also no difference in procedural complications (9 in RVP vs 2 in CSP, P = .09).

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.

Keywords: Conduction system pacing; His bundle pacing; Left bundle branch pacing; Randomized trial; Right ventricular pacing.

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Conflict of interest statement

Disclosures Authors from the Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, from Institute of Scientific Instruments, the Czech Academy of Sciences, and St. Anne’s University Hospital Brno have filed a US patent (No: US 11,517,243 B2) on the “Method of electrocardiographic signal processing and apparatus for performing the method.” KC, PJ, RS, and PL are shareholders of VDI Technologies. All remaining authors declare no conflicts of interest relevant to this study.

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