HRS 2019: No “home run superiority” for His-CRT compared with biventricular pacing


Roderick Tung (Chicago, USA) talks to BLearning Cardio about the results of the His-SYNC trial which he presented at HRS 2019.

The His-SYNC trial set out to compare the effectiveness of His bundle pacing compared with biventricular pacing as first-line therapy in patients with heart failure undergoing cardiac resynchronisation therapy (CRT).

Tung notes that while CRT has “been shown to save lives”, there is about a 30% non-response rate so “the question is how we can do better”.

The primary endpoints were change in QRS duration as measured by electrocardiography, improvement in left ventricular ejection fraction (LVEF) at six months and time to cardiovascular hospitalisation or death at 12 months.

Tung says that in regards to electrocardiographic resynchronisation, both therapies showed improvements, but while His bundle pacing was statistically significantly compared with its baseline, “there was no difference in between group comparison by intention to treat”. Additionally, in regards to LVEF, “there was a numerically higher rate of echocardiographic response seen with His”, but this was not the statistically significant “10% home run” needed for superiority.


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