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Getting the latest healthcare news for you
A new randomized trial shows conduction-system pacing (CSP) is noninferior to traditional biventricular pacing in heart failure patients with reduced ejection fraction. The His-Alternative II trial found both approaches delivered nearly identical reductions in left ventricular volume at 6 months. Experts say larger, longer studies are still needed before CSP can be firmly established as a first-line alternative.
The His-Alternative II randomized trial has found that conduction-system pacing (CSP) is noninferior to traditional biventricular pacing in patients with heart failure with reduced ejection fraction (HFrEF) who need cardiac resynchronization therapy (CRT). Presented at the ESC Congress 2026 in Munich and simultaneously published in JACC: Clinical Electrophysiology, the results add meaningful momentum to a growing body of evidence supporting CSP as a viable resynchronization strategy.
The trial enrolled 148 CRT candidates across two centers (Denmark and England), randomizing them 2:1 to CSP or biventricular pacing. Secondary outcomes — including CRT response rate, NYHA class change, 6-minute walk distance, and quality of life scores — were similar between groups, as were safety endpoints.
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Why it matters: While current ESC guidelines still list biventricular pacing as first-line therapy — particularly for LBBB patients — His-Alternative II strengthens the case for CSP. Experts note that larger trials with longer follow-up will likely be what it takes to shift guidelines.
