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Funding Acknowledgements Type of funding sources: None. BACKGROUND His bundle pacing (HBP), alone or optimized in association with coronary sinus pacing (HBP + LV) has recently been proposed as an alternative to conventional cardiac resynchronization therapy (CRT). However, there is lack of controlled studies that assessed clinical outcome. METHODS We did a single-centre, propensity-score matched, case-control study of comparison of HBP and HBP + LV versus conventional CRT in patients with heart failure (HF) and standard indications for CRT. The study group patients (n = 27) were consecutively enrolled in the years 2019. The control group patients (n = 27) were selected, by propensity score matching, among those CRT implantations performed, in the years 2015-2018. RESULTS In the active group, HBP alone was preferred in 12 (44%) patients, HBP + LV pacing in 12 (44%) patients and HBP failed in 3 (11%) patients. In the control group, conventional CRT was achieved in 26 (96%) patients and failed in one. Paced QRS width was shorter in the active than in the control group (128 ± 18 ms vs 148 ± 27 ms, p = 0.004). During a mean of 9.6 months of follow-up, in the intention-to-treat analysis, a composite clinical outcome of death, hospitalization for HF or worsening HF occurred in 3 (11%) in the active group and in 4 (15%) in the control group, p = 0.58. No difference was also observed with softer endpoints: NYHA class (1.9 ± 0.7 versus 2.1 ± 0.7), subjective improvement (74% versus 74%) and LV ejection fraction (40.7% versus 40.7%). CONCLUSION Compared with standard CRT, a shorter QRS width can be obtained with HBP alone or HBP + LV but we were unable to show a better clinical outcome. There is urgent need for large, randomized trials. Results by intention-to-treat analysisVariableActive groupN = 27Control groupN = 27PFollow-up, months9.7 ± 4.89.5 ± 4.50.90QRS width, ms128 ± 18148 ± 270.004Combined primary endpoint3 (11%)4 (15%)0.58• Death for HF10• Hospitalization for HF24• Worsening HF-1Subjective improvement20 (74%)20 (74%)1.24NYHA class1.9 ± 0.72.1 ± 0.70.15LV ejection fraction (%)40.7 ± 11.540.7 ± 12.21.00HF = heart failure; NYHA = New York Heart Association; LV = left ventricleAbstract Figure. Flow of active group patients

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Are His bundle pacing or His bundle plus coronary sinus pacing superior to conventional cardiac resynchronization therapy in improving heart failure? Results from a controlled study