His Pacing vs Biventricular Pacing for Cardiac Resynchronization Therapy | JACC: Clinical Electrophysiology

In this episode, Dr. Kenneth Ellenbogen, Deputy Editor of JACC: Clinical Electrophysiology, discusses new long-term findings from the His-Alternative I trial, the first European randomized study comparing His-bundle pacing with conventional biventricular pacing for cardiac resynchronization therapy (CRT). He highlights five-year outcomes demonstrating that when His-bundle pacing is achieved with low implant thresholds, its long-term performance—including lead stability, generator replacements, and clinical response—closely mirrors that of biventricular CRT. Dr. Ellenbogen explores the implications of these results for contemporary conduction system pacing practice, the importance of strict implant criteria, and how these data help refine patient selection and procedural strategy in CRT.