Trial reportEuropean heart journal. Cardiovascular Imaging2024
Longitudinal comparison of dyssynchrony correction and 'strain' improvement by conduction system pacing: LEVEL-AT trial secondary findings.
Trial report in European heart journal. Cardiovascular Imaging, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04054895 (LEft VEntricuLar Activation Time Shortening With Physiological Pacing vs Biventricular Resynchronization Therapy), which is not on this map. Cited by 11 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
LEft VEntricuLar Activation Time Shortening With Physiological Pacing vs Biventricular Resynchronization Therapy: a Randomized Study (LEVEL-AT)
Who cites it
11 citing papers in PubMed.
- Innovations in cardiac device therapy in the era of advanced rhythm management: implantable defibrillators and conduction system pacing.Heart (British Cardiac Society) · 2026Review
- Beyond QRS Duration: Myocardial Work Indices for the Assessment of Left Bundle Branch Block.Biomedicines · 2026Article
- Novel echocardiographic tools for predicting a good response to cardiac resynchronization therapy: a narrative review.Frontiers in cardiovascular medicine · 2026Review
- Prognostic implications of left ventricular mechanical dispersion in comparison with QRS duration in heart failure with reduced ejection fraction.Quantitative imaging in medicine and surgery · 2025Article
- Prediction and impact of high burden of ventricular pacing in patients with pacemaker after transcatheter aortic valve replacement.Heart rhythm O2 · 2025Article
- Left Ventricular Mechanical Dispersion and Its Value in Combination With Global Longitudinal Strain to Predict Reverse Remodeling in Patients With Heart Failure With Reduced Ejection Fraction.Journal of the American Heart Association · 2025Observational
- Echocardiographic imaging in patients with conduction system pacing.Cardiovascular ultrasound · 2025Review
- European Society of Cardiology (ESC) clinical consensus statement on indications for conduction system pacing, with special contribution of the European Heart Rhythm Association of the ESC and endorsed by the Asia Pacific Heart Rhythm Society, the Canadian Heart Rhythm Society, the Heart Rhythm Society, and the Latin American Heart Rhythm Society.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Article
- The Functional and Imaging Implications of Left Bundle Branch Pacing in Ischemic Cardiomyopathy.Biomolecules · 2025Review
- Conduction System Pacing: Where Are We in 2025?The Journal of innovations in cardiac rhythm management · 2025Article
- Mid-Term Impact of Conduction System Pacing on Overall Cardiac Performance: A Non-Randomized, Prospective, Single-Center Echocardiographic Study.Diseases (Basel, Switzerland) · 2024Article
Corrections and comments
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Authors and funding
19 authors.
Funding
Abstract
aimsLongitudinal dyssynchrony correction and 'strain' improvement by comparable cardiac resynchronization therapy (CRT) techniques is unreported. Our purpose was to compare echocardiographic dyssynchrony correction and 'strain' improvement by conduction system pacing (CSP) vs. biventricular pacing (BiVP) as a marker of contractility improvement during 1-year follow-up. METHODS AND
resultsA treatment-received analysis was performed in patients included in the LEVEL-AT trial (NCT04054895), randomized to CSP or BiVP, and evaluated at baseline (ON and OFF programming) and at 6 and 12 months (n = 69, 32% women). Analysis included intraventricular (septal flash), interventricular (difference between left and right ventricular outflow times), and atrioventricular (diastolic filling time) dyssynchrony and 'strain' parameters [septal rebound, global longitudinal 'strain' (GLS), LBBB pattern, and mechanical dispersion). Baseline left ventricular ejection fraction (LVEF) was 27.5 ± 7%, and LV end-systolic volume (LVESV) was 138 ± 77 mL, without differences between groups. Longitudinal analysis showed LVEF and LVESV improvement (P < 0.001), without between-group differences. At 12-month follow-up, adjusted mean LVEF was 46% with CSP (95% CI 42.2 and 49.3%) vs. 43% with BiVP (95% CI 39.6 and 45.8%), (P = 0.31), and LVESV was 80 mL (95% CI 55.3 and 104.5 mL) vs. 100 mL (95% CI 78.7 and 121.6 mL), respectively (P = 0.66). Longitudinal analysis showed a significant improvement of all dyssynchrony parameters and GLS over time (P < 0.001), without differences between groups. Baseline GLS significantly correlated with LVEF and LVESV at 12-month follow-up.
conclusionCSP and BiVP provided similar dyssynchrony and 'strain' correction over time. Baseline global longitudinal 'strain' predicted ventricular remodelling at 12-month follow-up.
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