Trial reportEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2025
Conduction system pacing vs. biventricular pacing for cardiac resynchronization: the CSP-SYNC randomized single centre study.
Trial report in 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, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
18 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Conduction system vs. biventricular pacing in heart failure with reduced ejection fraction: a meta-analysis of randomized controlled trials.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 · 2026Pooled it
- Conduction system pacing vs. biventricular pacing for cardiac resynchronization therapy in heart failure: a systematic review and meta-analysis considering randomized controlled trials and observational studies.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 · 2026Pooled it
- Conduction system pacing for cardiac resynchronization therapy: a systematic review.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 · 2026Pooled it
- Role of Atrial Pacing Support in Cardiac Resynchronization Therapy: A Noninferiority Randomized Trial.Circulation · 2026Trial
- Conduction System vs Biventricular Pacing in Heart Failure: The PhysioSync-HF Randomized Clinical Trial.JAMA cardiology · 2026Trial
- Left Bundle Branch Area Pacing in Heart Failure: A Physiological Alternative to Conventional Biventricular Cardiac Resynchronization Therapy and a Step Towards Personalized Device Therapy.Journal of personalized medicine · 2026Review
- Cardiac implantable electronic devices in heart failure: needs, challenges, and real-world implementation.Heart failure reviews · 2026Review
- Innovations in cardiac device therapy in the era of advanced rhythm management: implantable defibrillators and conduction system pacing.Heart (British Cardiac Society) · 2026Review
- Electromechanical window as an integrative marker of remodeling and arrhythmic risk in biventricular vs. left bundle branch area pacing.The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology · 2026Article
- Conduction system pacing: what emerging evidence and what indications?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 · 2026Review
- Differential Time Course of LVEF Recovery Between Conduction System Pacing Versus Biventricular Pacing.JACC. Asia · 2026Article
- Impact of Left Bundle Branch Area Pacing on Echocardiographic Parameters and Symptoms: Data From the Conduction System Pacing Italian Network Group (C-SING) Study.Journal of cardiovascular electrophysiology · 2026Observational
- Comparison of tricuspid regurgitation after cardiac resynchronization therapy-defibrillator implantation using left bundle branch area pacing versus biventricular pacing.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Article
- Cardiac Resynchronization Therapy: A Review.JAMA · 2026Review
- Cardiac resynchronization therapy in very old patients with pacemakers: a cardiogeriatric, physiology-based approach.Aging clinical and experimental research · 2026Review
- Conduction system pacing compared with biventricular pacing for cardiac resynchronization therapy: a systematic review and meta-analysis.Frontiers in cardiovascular medicine · 2026Review
- Controversy: in heart failure patients with a reduced ejection fraction and left bundle branch block, conduction system pacing can be a valid alternative to biventricular pacing-pro and contra.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 · 2025Review
- Comparing Conduction System Pacing to Biventricular Upgrade in Pacemaker-Induced Cardiomyopathy: A Retrospective Observational Study.Journal of clinical medicine · 2025Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
aimsThere are limited prospective randomized studies comparing left bundle branch area pacing (LBBAP) and biventricular (BiV) pacing for cardiac resynchronization therapy (CRT). The study tested whether LBBAP is non-inferior to BiV pacing in patients with Class I indication for CRT. METHODS AND
resultsThe CSP-SYNC study is an investigator-initiated, randomized, single-centre study. Sixty-two patients were randomized 1:1 to LBBAP or BiV. The primary study endpoint was the change in left ventricular ejection fraction (LVEF) at 6 months. Secondary endpoints included changes in echo and clinical parameters after 6 months and 12 months. Thirty-one patients were randomized to each arm. Most patients were males (71%), and 32% had ischaemic cardiomyopathy. At 6 months, similar improvement of LVEF was observed in the LBBAP group compared to the BiV group [14.0% (95% confidence interval (CI): 11.2-16.8) in LBBAP vs. 8.5% (95% CI: 5.6-11.2) in BiV] with a mean intergroup difference of 5.6% (95% CI: 1.6-9.5; P < 0.001 for non-inferiority). Both groups showed comparable decrease in LVESV [-64 mL (95% CI: -78 to -50) vs. -40 mL (95% CI: -54 to -25) respectively, mean difference -24 mL (CI 95%: -44 to -4); P < 0.001 for non-inferiority] and changes in 6-min walk test (P < 0.001 for non-inferiority) and NYHA class (P = 0.011 for non-inferiority). Temporal trends of LV remodelling and heart failure hospitalization rates were also comparable.
conclusionIn patients with a Class I indication for CRT, LBBAP was non-inferior to BiV pacing in improving LVEF and provided similar structural and electrical remodelling.
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