Biventricular vs conduction system pacing after atrioventricular node ablation for heart failure with atrial fibrillation: the CONDUCT-AF trial

IF 45.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Heart Journal Pub Date : 2026-10-06 DOI:10.1093/eurheartj/ehag699

David Žižek,Maja Ivanovski,Miha Mrak,Catalin Pestrea,Ecaterina Cicala,Sandro Brusich,Ivana Grgić Romić,Peter Bógyi,Gábor Zoltán Duray,Sebastiaan Dhont,Vassil Traykov,Josip Kedžo,Matevž Jan,Miroslav Krpan,Luka Klemen,Bor Antolič,Jakob Peterlin,Tadej Žlahtič,Tomaž Podlesnikar,Wilfried Mullens,Anja Zupan Mežnar,of CONDUCT-AF Investigators,David Žižek,Anja Zupan Mežnar,Wilfried Mullens,Miha Mrak,Sandro Brusich,Matjaž Šinkovec,Andrej Pernat,Zlatko Fras,Maja Ivanovski,Tomaž Podlesnikar,Jakob Peterlin,Tadej Žlahtič,Bor Antolič,Martin Rauber,Luka Klemen,Nastja Žgalin,Kristian Franić,Tanja Andoljšek Simonič,Matevž Jan,Jernej Štublar,Catalin Pestrea,Ecaterina Cicala,Roxana Enache,Peter Bogyi,Gabor Zoltan Duray,Balazs Polgar,Nikolett Vigh,Ivana Grgić Romić,Ana Lanča Bastiančić,David Židan,Zrinka Jurišić,Josip Kedžo,Borka Pezo Nikolić,Miroslav Krpan,Vassil Traykov,Momchil Marinov,Denislav Boychev,Emiliyan Martinov,Daniel Marchov,Gergana Litsova,Vyara Konstantinova,Sebastiaan Dhont,Jonas Erzeel,Günther Prenner

{"title":"Biventricular vs conduction system pacing after atrioventricular node ablation for heart failure with atrial fibrillation: the CONDUCT-AF trial","authors":"David Žižek,Maja Ivanovski,Miha Mrak,Catalin Pestrea,Ecaterina Cicala,Sandro Brusich,Ivana Grgić Romić,Peter Bógyi,Gábor Zoltán Duray,Sebastiaan Dhont,Vassil Traykov,Josip Kedžo,Matevž Jan,Miroslav Krpan,Luka Klemen,Bor Antolič,Jakob Peterlin,Tadej Žlahtič,Tomaž Podlesnikar,Wilfried Mullens,Anja Zupan Mežnar,of CONDUCT-AF Investigators,David Žižek,Anja Zupan Mežnar,Wilfried Mullens,Miha Mrak,Sandro Brusich,Matjaž Šinkovec,Andrej Pernat,Zlatko Fras,Maja Ivanovski,Tomaž Podlesnikar,Jakob Peterlin,Tadej Žlahtič,Bor Antolič,Martin Rauber,Luka Klemen,Nastja Žgalin,Kristian Franić,Tanja Andoljšek Simonič,Matevž Jan,Jernej Štublar,Catalin Pestrea,Ecaterina Cicala,Roxana Enache,Peter Bogyi,Gabor Zoltan Duray,Balazs Polgar,Nikolett Vigh,Ivana Grgić Romić,Ana Lanča Bastiančić,David Židan,Zrinka Jurišić,Josip Kedžo,Borka Pezo Nikolić,Miroslav Krpan,Vassil Traykov,Momchil Marinov,Denislav Boychev,Emiliyan Martinov,Daniel Marchov,Gergana Litsova,Vyara Konstantinova,Sebastiaan Dhont,Jonas Erzeel,Günther Prenner","doi":"10.1093/eurheartj/ehag699","DOIUrl":null,"url":null,"abstract":"Abstract Background and Aims Randomized evidence comparing conduction system pacing (CSP) and biventricular pacing (BVP) following atrioventricular node ablation in patients with refractory atrial fibrillation (AF) and heart failure (HF) remains limited. This study evaluated whether CSP with left bundle branch area pacing is non-inferior to BVP in patients undergoing atrioventricular node ablation. Methods CONDUCT-AF was an investigator-initiated, multicentre, randomized trial conducted across 10 European centres. Patients with refractory AF, HF with left ventricular ejection fraction (LVEF) &lt; 50%, narrow QRS duration (≤120 ms), and N-terminal pro-B-type natriuretic peptide &gt; 600 ng/L were randomized 1:1 to CSP or BVP. The primary endpoint was the change in LVEF after 6 months, assessed by an independent core laboratory. Secondary endpoints included echocardiographic, clinical, and procedural outcomes. Analyses followed the intention-to-treat principle. Results Eighty-two patients were randomized (mean age 72 ± 7 years, 46% male). At 6 months, LVEF improved similarly in CSP {from 36% [95% confidence interval (CI) 33–39] to 46% [95% CI 44–49]; P &lt; .001} and BVP group [from 34% (95% CI 31–36) to 46% (95% CI 43–49); P &lt; .001]. The between-group difference was .4% (95% CI −3.1–3.8; P = .002 for non-inferiority). Changes in left ventricular volumes, clinical parameters, and composite endpoint of worsening HF or cardiovascular death were comparable between groups. Paced QRS [mean difference −14 ms (95% CI −19 to −9; P &lt; .001)] and procedural and fluoroscopy times were significantly shorter with CSP compared with BVP. Conclusions In HF patients with refractory AF undergoing atrioventricular node ablation, CSP with left bundle branch area pacing was non-inferior to BVP for LVEF improvement at 6 months, providing comparable clinical outcomes and a favourable procedural profile.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"13 1","pages":""},"PeriodicalIF":45.3000,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Heart Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/eurheartj/ehag699","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Abstract Background and Aims Randomized evidence comparing conduction system pacing (CSP) and biventricular pacing (BVP) following atrioventricular node ablation in patients with refractory atrial fibrillation (AF) and heart failure (HF) remains limited. This study evaluated whether CSP with left bundle branch area pacing is non-inferior to BVP in patients undergoing atrioventricular node ablation. Methods CONDUCT-AF was an investigator-initiated, multicentre, randomized trial conducted across 10 European centres. Patients with refractory AF, HF with left ventricular ejection fraction (LVEF) < 50%, narrow QRS duration (≤120 ms), and N-terminal pro-B-type natriuretic peptide > 600 ng/L were randomized 1:1 to CSP or BVP. The primary endpoint was the change in LVEF after 6 months, assessed by an independent core laboratory. Secondary endpoints included echocardiographic, clinical, and procedural outcomes. Analyses followed the intention-to-treat principle. Results Eighty-two patients were randomized (mean age 72 ± 7 years, 46% male). At 6 months, LVEF improved similarly in CSP {from 36% [95% confidence interval (CI) 33–39] to 46% [95% CI 44–49]; P < .001} and BVP group [from 34% (95% CI 31–36) to 46% (95% CI 43–49); P < .001]. The between-group difference was .4% (95% CI −3.1–3.8; P = .002 for non-inferiority). Changes in left ventricular volumes, clinical parameters, and composite endpoint of worsening HF or cardiovascular death were comparable between groups. Paced QRS [mean difference −14 ms (95% CI −19 to −9; P < .001)] and procedural and fluoroscopy times were significantly shorter with CSP compared with BVP. Conclusions In HF patients with refractory AF undergoing atrioventricular node ablation, CSP with left bundle branch area pacing was non-inferior to BVP for LVEF improvement at 6 months, providing comparable clinical outcomes and a favourable procedural profile.

查看原文本刊更多论文

心房颤动心衰房室结消融后双室vs传导系统起搏：传导-心房颤动试验

背景与目的比较传导系统起搏（CSP）和双心室起搏（BVP）在难治性心房颤动（AF）和心力衰竭（HF）患者房室结消融后的随机证据仍然有限。本研究评估了左束支区域起搏对房室结消融患者的CSP效果是否优于BVP。CONDUCT-AF是一项研究者发起的、多中心的随机试验，在10个欧洲中心进行。难治性房颤、心衰伴左室射血分数（LVEF）患者&；lt；50%，窄QRS持续时间（≤120 ms）， n端前b型利钠肽&；gt；600 ng/L随机分为CSP组和BVP组。主要终点是6个月后LVEF的变化，由一个独立的核心实验室评估。次要终点包括超声心动图、临床和手术结果。分析遵循意向治疗原则。结果随机选取82例患者，平均年龄72±7岁，男性占46%。在6个月时，LVEF对CSP的改善类似，从36%[95%可信区间（CI） 33-39]提高到46% [95% CI 44-49]；P, lt;．001}和BVP组[从34% （95% CI 31-36）到46% (95% CI 43-49)；P, lt;措施)。组间差异为。4% （95% CI−3.1-3.8；非劣效性P = 0.002）。两组间左心室容积、临床参数和心衰恶化或心血管死亡复合终点的变化具有可比性。节律性QRS[平均差- 14 ms] (95% CI - 19至- 9；P <；与BVP相比，CSP的手术时间和透视时间明显缩短。结论：在接受房室结消融的难治性房颤患者中，CSP联合左束支区起搏在6个月时改善LVEF的效果不逊于BVP，提供了相似的临床结果和良好的手术效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

European Heart Journal 医学-心血管系统

CiteScore

39.30

自引率

6.90%

发文量

3942

审稿时长

1 months

期刊介绍： The European Heart Journal is a renowned international journal that focuses on cardiovascular medicine. It is published weekly and is the official journal of the European Society of Cardiology. This peer-reviewed journal is committed to publishing high-quality clinical and scientific material pertaining to all aspects of cardiovascular medicine. It covers a diverse range of topics including research findings, technical evaluations, and reviews. Moreover, the journal serves as a platform for the exchange of information and discussions on various aspects of cardiovascular medicine, including educational matters. In addition to original papers on cardiovascular medicine and surgery, the European Heart Journal also presents reviews, clinical perspectives, ESC Guidelines, and editorial articles that highlight recent advancements in cardiology. Additionally, the journal actively encourages readers to share their thoughts and opinions through correspondence.