{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:51:04Z","timestamp":1787028664031,"version":"build-2736575974"},"reference-count":38,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Cardiac resynchronization therapy with defibrillator (CRT-D) is a well-established therapy for patients with heart failure (HF) and intraventricular conduction delays, but a non-negligible risk of infection and of lead functionality loss overtime is related to intravascular hardware. The novel DX system enables atrial sensing through a floating dipole integrated into the ICD lead, reducing the intravascular burden. In this prospective non-randomized study, we aimed to evaluate the safety and efficacy of a two-lead DX-based CRT system compared to a conventional three-lead (3L) CRT-D system. Methods: A total of 210 patients meeting CRT indications and no signs of sick sinus syndrome (SSS) (baseline HR \u2265 45 bpm, or at least 85 bpm at 6 min walking test) were enrolled. Patients were assigned to either the CRT-DX or conventional 3L CRT-D group. The primary endpoint was a composite clinical response, defined as the freedom from cardiovascular death, HF hospitalization, or new-onset atrial fibrillation (AF). Results: After a mean follow-up of 46.5 \u00b1 1.9 months, both groups had comparable clinical and instrumental outcomes. CRT-DX patients exhibited higher atrial sensing amplitudes and no significant differences in loss of lead function. Conclusions: In conclusion, the CRT-DX system provides equivalent clinical and echocardiographic benefits compared to conventional CRT-D in patients without an indication for atrial pacing. This supports the use of the DX system as a safe and effective alternative in the majority of CRT recipients.<\/jats:p>","DOI":"10.3390\/jcm14248746","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T16:11:18Z","timestamp":1765383078000},"page":"8746","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Comparative Analysis of Two-Lead DX-Based CRT Versus Conventional Three-Lead CRT-D: Results from a Single-Center Prospective Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3877-3239","authenticated-orcid":false,"given":"Alessandro","family":"Carecci","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4590-8584","authenticated-orcid":false,"given":"Mauro","family":"Biffi","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6411-0561","authenticated-orcid":false,"given":"Mirco","family":"Lazzeri","sequence":"additional","affiliation":[{"name":"Cardiovascular Department, San Donato Hospital, 52100 Arezzo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Quaranta","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8437-0222","authenticated-orcid":false,"given":"Lorenzo","family":"Bartoli","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8452-7405","authenticated-orcid":false,"given":"Alberto","family":"Spadotto","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Martignani","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Angeletti","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3823-3809","authenticated-orcid":false,"given":"Igor","family":"Diemberger","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1227-5787","authenticated-orcid":false,"given":"Giulia","family":"Massaro","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Ziacchi","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. 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