Conduction System Pacing Versus Biventricular Resynchronization in Patients With Chronic Heart Failure

Inclusion criteria: * Male or female, age ≥18 years * Established diagnosis of symptomatic heart failure (New York Heart Association class II-III) * Left ventricular ejection fraction ≤35% in prior 3 months * Left bundle branch block (QRS ≥130 ms) * Clinical indication for cardiac resynchronization therapy * Patients should be clinically stable * Patients should receive background standard of care for heart failure with reduced ejection fraction, with the maximum tolerated doses of ACE inhibitor or ARB or ARNI, beta-blocker, and mineralocorticoid receptor antagonist Exclusion criteria: * Life expectancy \<12 months due to any disease * Dementia or advanced cerebrovascular disease * NYHA class IV * Plan to implant an implantable cardioverter defibrillator (ICD), with or without resynchronization therapy (CRT-D) * Enrollment in other clinical trials involving cardiac pacing * Pregnancy or pre-menopausal women who do not use regular contraceptive methods * Patients unable to understand and sign the consent for participation