- Design
- Randomised, multicentre, investigator-initiated, non-inferiority
- Population
- 82 patients with refractory AF, LVEF <50%, narrow QRS, undergoing AV node ablation
- Primary outcome
- Change in LVEF at 6 months (core laboratory)
- Effect
- 36%→46% vs 34%→46%; difference 0.4 points (95% CI −3.1 to 3.8)
CONDUCT-AF was an investigator-initiated randomised trial at 10 European centres. It enrolled 82 patients with refractory AF, heart failure with LVEF below 50%, a narrow QRS and NT-proBNP above 600 ng/L, all undergoing AV node ablation, and allocated them to left bundle branch area pacing or biventricular pacing.
At six months, core-laboratory LVEF rose from 36% to 46% with conduction system pacing and from 34% to 46% with biventricular pacing — a between-group difference of 0.4 points, meeting non-inferiority. Ventricular volumes and the composite of worsening heart failure or cardiovascular death were similar. Paced QRS was 14 ms narrower, and procedure and fluoroscopy times were shorter.
This is a small trial with a surrogate primary endpoint, so it settles the echo question rather than the outcomes question. For a pace-and-ablate strategy it supports conduction system pacing as a reasonable first choice in experienced hands.
- Consider left bundle branch area pacing as an alternative to biventricular pacing before AV node ablation.
- Expect similar LVEF recovery at six months with either approach.
- Factor in shorter procedure and fluoroscopy times when choosing.
- Refer to an operator with established conduction system pacing experience.
Why it matters
It gives randomised support to a simpler device strategy for one of the commonest ablate-and-pace scenarios.
Don't overread it
With 82 patients and an echo endpoint, it cannot show equivalence for death or hospital admission.
The statistics, in plain English
Non-inferiority means the new approach was shown not to be meaningfully worse, within a pre-set margin. The difference of 0.4 points (95% CI −3.1 to 3.8) sits close to zero, but the interval is wide enough that a small difference either way cannot be excluded.
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