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Background <p>Cardiac resynchronization therapy(CRT) improves outcomes in heart failure with electrical dyssynchrony, yet non-response remains common. Direct measurement of spontaneous interventricular conduction delay (RV–LV), may better guide therapy and inform the choice between biventricular pacing (BiVp) and conduction system pacing (CSP).</p> Objectives <p>To compare CSP with BiVp in terms of reverse remodelling and to assess the predictive value of RV–LV delay.</p> Methods <p>184 consecutive CRT recipients were prospectively analyzed on an as-treated basis.All patients underwent RV–LV assessment, and were classified into three groups: BiVp with RV–LV &lt; 100 ms, BiVp with RV–LV ≥ 100 ms, or CSP. Co-primary endpoints were change in ejection fraction (ΔEF) and echocardiographic responder rate at 12 months. An echocardiographic responder was defined as ≥ 15% reduction in LV end-systolic volume or an increase in LVEF ≥ 10%.</p> Results <p>CSP was non-inferior to BiVp for ΔEF (mean difference − 0.8% points). Non-inferiority was not demonstrated for responder rate, despite a numerical advantage for CSP (77.2% vs. 66.5%). Patients with BiVp ≥ 100 ms and those treated with CSP achieved greater ΔEF (~ 12%) and higher responder rates (~ 77%) compared with BiVp &lt; 100 ms (ΔEF 8%,responders 51%). On multivariable analysis, pacing strategy and interventricular delay were independent predictors of response, whereas ischaemic aetiology was a negative predictor.</p> Conclusions <p>CSP represents an effective bailout strategy when BiVp fails to achieve adequate electrical resynchronization. BiVp effectiveness depends on the degree of interventricular electrical resynchronization achieved. These findings support an electrically guided, personalized CRT approach, in which the quality of resynchronization rather than pacing modality alone drives reverse remodelling.</p>

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Interventricular conduction delay predicts CRT response: a comparative evaluation study between biventricular pacing and conduction system pacing

  • 期刊论文

  • 发表日期：

    2026年3月7日

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  • Amato Santoro,
  • Maurizio Collantoni,
  • Simone Taddeucci,
  • Federico Landra,
  • Claudia Baiocchi,
  • Francesco Morrone,
  • Carmine Marallo,
  • Antonio Pagliaro,
  • Stefano Lunghetti,
  • Laura Spaccaterra,
  • Niccolò Manetti,
  • Matteo Cameli,
  • Massimo Fineschi

摘要

Background

Cardiac resynchronization therapy(CRT) improves outcomes in heart failure with electrical dyssynchrony, yet non-response remains common. Direct measurement of spontaneous interventricular conduction delay (RV–LV), may better guide therapy and inform the choice between biventricular pacing (BiVp) and conduction system pacing (CSP).

Objectives

To compare CSP with BiVp in terms of reverse remodelling and to assess the predictive value of RV–LV delay.

Methods

184 consecutive CRT recipients were prospectively analyzed on an as-treated basis.All patients underwent RV–LV assessment, and were classified into three groups: BiVp with RV–LV < 100 ms, BiVp with RV–LV ≥ 100 ms, or CSP. Co-primary endpoints were change in ejection fraction (ΔEF) and echocardiographic responder rate at 12 months. An echocardiographic responder was defined as ≥ 15% reduction in LV end-systolic volume or an increase in LVEF ≥ 10%.

Results

CSP was non-inferior to BiVp for ΔEF (mean difference − 0.8% points). Non-inferiority was not demonstrated for responder rate, despite a numerical advantage for CSP (77.2% vs. 66.5%). Patients with BiVp ≥ 100 ms and those treated with CSP achieved greater ΔEF (~ 12%) and higher responder rates (~ 77%) compared with BiVp < 100 ms (ΔEF 8%,responders 51%). On multivariable analysis, pacing strategy and interventricular delay were independent predictors of response, whereas ischaemic aetiology was a negative predictor.

Conclusions

CSP represents an effective bailout strategy when BiVp fails to achieve adequate electrical resynchronization. BiVp effectiveness depends on the degree of interventricular electrical resynchronization achieved. These findings support an electrically guided, personalized CRT approach, in which the quality of resynchronization rather than pacing modality alone drives reverse remodelling.