{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T22:08:36Z","timestamp":1788559716870,"version":"build-2803163510"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Biotronik","award":["CRT-Next"],"award-info":[{"award-number":["CRT-Next"]}]}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"\n BACKGROUND:<\/jats:title>\n The role of atrial pacing support is unclear in patients receiving cardiac resynchronization therapy\u2013defibrillator (CRT-D) without sinus node dysfunction.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n We conducted a randomized, parallel-group, noninferiority trial to evaluate whether a 2-lead CRT-D capable of atrial sensing (but no pacing) by a floating dipole on the right ventricular lead (CRT-DX) is not inferior to a 3-lead CRT-D with a conventional atrial lead. Between October 17, 2018, and March 5, 2024, a total of 636 patients (68\u00b110 years old, 28.6% women) with standard CRT-D indication, optimized medical therapy, and resting sinus rate \u226545 beats\/min were randomized 1:1 to CRT-DX (atrial tracking without atrial pacing mode 35 beats\/min) or CRT-D (atrial tracking with atrial pacing mode 50 beats\/min) at 23 Italian sites. A centralized block-randomization procedure stratified by site was used, with patients and primary outcome assessors blinded to treatment assignment. The primary end point was a 1-year composite of all-cause mortality, cardiovascular hospitalization, and lead-related complications (loss of functionality not correctable by device reprogramming). Secondary end points included each individual component of the primary end point separately, echocardiographic reverse remodeling, and 6-minute walk test distance at 12 months.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n The primary end point occurred in 41 (13.1%) patients in the CRT-DX group and 47 (15.6%) patients in the CRT-D group, corresponding to a hazard ratio of 0.82 (95% CI, 0.54\u20131.25). This confirmed noninferiority (prespecified relative margin of 1.20) in both the per-protocol (\n P<\/jats:italic>\n =0.039) and intention-to-treat (\n P<\/jats:italic>\n =0.044) analyses. Individual components showed no significant differences, except for lead complications related to right atrial functionality (4 [1.3%] patients in the CRT-DX group versus 13 [4.2%] patients in the CRT-D group;\n P<\/jats:italic>\n =0.040). Reverse remodeling responders were 203 (77.5% of 262) patients receiving CRT-DX and 190 (76.3% of 249) patients receiving CRT-D (\n P<\/jats:italic>\n =0.83). Walking distance did not differ between 2 study arms (404 versus 398 m;\n P<\/jats:italic>\n =0.62). After a median follow-up of 2.4 years, only 1 patient receiving CRT-DX required implantation of a standard atrial lead.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n The 2-lead CRT-DX system without atrial pacing is noninferior to conventional 3-lead CRT-D, with fewer atrial lead\u2013related complications.<\/jats:p>\n <\/jats:sec>\n \n REGISTRATION:<\/jats:title>\n \n URL:\n https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n ; Unique identifier: NCT03587064.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/circulationaha.126.079859","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T13:30:06Z","timestamp":1774877406000},"page":"1707-1718","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Role of Atrial Pacing Support in Cardiac Resynchronization Therapy: A Noninferiority Randomized Trial"],"prefix":"10.1161","volume":"153","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4590-8584","authenticated-orcid":true,"given":"Mauro","family":"Biffi","sequence":"first","affiliation":[{"name":"Cardiology Unit, Institute of Cardiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Italy (M. Biffi)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5541-0723","authenticated-orcid":true,"given":"Giovanni","family":"Rovaris","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy (G.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0187-0492","authenticated-orcid":true,"given":"Ennio Carmine Luigi","family":"Pisan\u00f2","sequence":"additional","affiliation":[{"name":"Cardiology and Intensive Care Unit, Vito Fazzi Hospital, Lecce, Italy (E.C.L.P.)."},{"name":"Cardiology Unit, \u201cA. Perrino\u201d Hospital, Brindisi, Italy (E.C.L.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7218-8781","authenticated-orcid":true,"given":"Valeria","family":"Calvi","sequence":"additional","affiliation":[{"name":"Cardiology Department, G. Rodolico\u2014San Marco University Hospital, Catania, Italy (V.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4739-7004","authenticated-orcid":true,"given":"Antonio","family":"Rapacciuolo","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (A.R.)."},{"name":"Ospedale Evangelico Betania, Naples, Italy (A.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1000-0592","authenticated-orcid":true,"given":"Matteo","family":"Santamaria","sequence":"additional","affiliation":[{"name":"Electrophysiology and Arrhythmology Unit, Responsible Research Hospital, Campobasso, Italy (M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giampiero","family":"Maglia","sequence":"additional","affiliation":[{"name":"Arrhythmology Unit, Tirrenia Hospital, Belvedere Marittimo, Italy (G.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Zanotto","sequence":"additional","affiliation":[{"name":"Cardiology Department, Azienda Ulss 9 Scaligera, Villafranca, Italy (G.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3878-2904","authenticated-orcid":true,"given":"Emanuele","family":"Bertaglia","sequence":"additional","affiliation":[{"name":"Cardiology Department, Camposampiero Hospital\u2014AULSS 6 Euganea, Padova, Italy (E.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1776-8449","authenticated-orcid":true,"given":"Gerardo","family":"Nigro","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania \u201cLuigi Vanvitelli,\u201d Second University of Naples, Italy (G.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3604-4830","authenticated-orcid":true,"given":"Andrea","family":"Giomi","sequence":"additional","affiliation":[{"name":"Department of Medical Specialities, Azienda USL Toscana Centro, Santa Maria Nuova Hospital, Florence, Italy (A. 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