Pacing Strategy Research Articles

Atrioventricular Block Treatment: Pacing Site, AV Synchrony, or Both?

Background/Objectives: Right ventricular pacing (RVP), leadless pacing (LL), and conduction system pacing (CSP) are treatment options for atrioventricular block (AVB), each with distinct characteristics. However, the long-term outcomes of these pacing strategies remain insufficiently compared. This study evaluates clinical and echocardiographic outcomes of patients with AVB treated with dual chamber RVP, His bundle pacing (HBP), or LL. Methods: This single-center observational registry study included 22 consecutive patients receiving LL with atrioventricular resynchronization functionality (October 2020 to October 2022), matched with 66 control patients receiving either RVP (33 patients) or HBP (33 patients) using propensity score matching (2:3:3 ratio). Primary and secondary endpoints included all-cause mortality, cardiovascular mortality, heart failure, and echocardiographic outcomes. Atrioventricular synchrony in the LL group was assessed. Results: At two years, all-cause mortality was significantly higher in the LL group compared to RVP (36.4% vs. 6.1%, p = 0.002) and HBP (36.4% vs. 12.1%, p = 0.03), but LL had a more severe clinical profile. Cardiovascular mortality and heart failure incidence showed no significant differences. Patients receiving RVP showed a significant decrease in left ventricular ejection fraction and an increase in ventricular volumes. In contrast, HBP patients exhibited favorable cardiac remodeling. Stratification based on atrial sensing showed that LL patients with >66% AV synchrony had a lower mortality (p = 0.02). Conclusions: CSP offers superior results compared to other pacing methods in terms of ventricular function owing to a physiological ventricular activation and maintenance of AV synchrony. However, LL may be a viable alternative for frail and high-risk patients, as the suboptimal AV synchrony is traded off with lesser ventricular dyssynchrony.

Pacing Strategy and Resulting Performance of Elite Trail Runners: Insights From the 2023 World Mountain and Trail Running Championships.

Pacing is crucial in endurance sports such as running, and its importance is also prominent in trail running due to the unique challenges, including high elevation gains and varied terrain. This study aimed to explore the pacing strategies of elite athletes during the 2023 World Mountain and Trail Running Championships for the Trail Short distance. The participants included 12 elite trail runners who provided their race data from sport watches for analysis. The findings indicate a significant decrease in grade-adjusted pace (vi) as the race progressed, with an average change of -18.7% from the start to the last downhill segment. A linear correlation of -.55 (P = .031) was observed between the winning time and the evolution of vi, suggesting that more consistent pacing led to better performance. The Student t test (t = 2.628, numerator degrees of freedom = 10, P = .013) confirmed that even pacing is significantly correlated with superior race results at a confidence level above 95%. A more even pacing strategy is associated with success during elite trail-running races.

The Sub 2-h Official Marathon is Possible: Developing a Drafting Strategy for a Historic Breakthrough in Sports

BackgroundDrafting for drag reduction is a tactic commonly employed by elite athletes of various sports. The strategy has been adopted by Kenyan runner Eliud Kipchoge on numerous marathon events in the past, including the 2018 and 2022 editions of the Berlin marathon (where Kipchoge set two official world records), as well as in two special attempts to break the 2 h mark for the distance, the Nike Breaking2 (2017) and the INEOS 1:59 Challenge (2019), where Kipchoge used an improved drafting formation to finish in 1:59:40, although that is not recognized as an official record.ResultsIn this study, the drag of a realistic model of a male runner is calculated by computational fluid dynamics for a range of velocities. The formations employed in the past by Kipchoge, as well as alternative formations, are analyzed and systematically compared with respect to mechanical power. In a quest to show that running an official marathon in under 2 h is possible, the power analysis is extended to the pacers. We developed a simple drafting and pacing strategy that Kipchoge could have used to run the 2022 Berlin marathon in a surprising 1 h, 59 min and 48 s.ConclusionsElite marathon runners can make better use of the pacers to experience reduced drag in races. The associated energy reduction makes it possible to run faster, finishing the race in less time. Using a better drafting strategy and a positive splitting pacing strategy, Kenyan runner Eliud Kipchoge could have broken the sub 2 h barrier in both the 2018 and 2022 editions of Berlin Marathon.

Exercise expectation changes psychophysiological responses to sprint exercise regardless of changes in pacing and performance

ABSTRACT Deception of exercise-related may influence pacing, performance and psychophysiological responses to continuous exercise, but little is known about such effects on sprint exercises. Most sports modalities are intermittent in nature, so the present study verified if sprint exercise expectation deceived by false information influenced pacing strategy, performance and psychophysiological responses to sprint exercise bouts. We hypothesised that pacing and performance would be based on affective valence in this deception study. Eleven road cyclists performed two sprint interval training (SIT) sessions in counterbalanced order. In one session, we deceived participants by informing them they would perform a more physiologically challenging exercise bout (MDDE) when compared with the control session (CON). Psychophysiological variables such as oxygen uptake, lactate, heart rate (HR), feeling scale, felt arousal scale and ratings of perceived exertion (RPE) were sampled during or after each sprint in SIT protocols. We observed no effect on pacing and performance assessed as power output, regardless of the worsened affective valence in the MDEE session. Furthermore, null effects were detected in most psychophysiological variables, with the exception of HR and affective valence. Performance in both SIT conditions was strongly correlated with affective valence and RPE. These results challenged the role of affective valence on pacing regulation and performance in sprint exercises.

Leadless Pacemaker vs. Transvenous Pacemaker in End Stage Kidney Disease: Insights from the Nationwide Readmission Database.

Background: Leadless pacemakers offer a safe and effective alternative pacing strategy. However, limited data are available for patients with end stage renal disease (ESRD), a population of significant relevance. Methods: Using the Nationwide Readmission Database, we extracted data from all adult patients with ESRD who underwent traditional transvenous or leadless pacemaker implantation between 2016 and 2021. We compared in-hospital mortality, 30-day readmission rates, complication rates, and healthcare resource utilization between the two cohorts. Results: A total of 6384 (81.2%) patients were included in the transvenous pacemaker cohort, and 1481(18.8%) patients were included in the leadless pacemaker cohort. In patients with ESRD, leadless pacemaker implantation was linked to higher in-hospital complications when compared to transvenous pacemakers. These included the need for blood transfusion (aOR 1.85, 95% CI 1.32-2.60, p < 0.01), vascular complications (aOR 3.6, CI 1.40-9.26, p = 0.01), and cardiac complications (aOR 4.12, CI 1.70-9.98, p < 0.01). However, there were no differences between the two groups in terms of in-hospital mortality and 30-day readmission rates. The median length of stay was longer for leadless pacemaker implantation than transvenous pacemaker implantation (5 days vs. 4 days, p < 0.01). The total hospitalization charges were also higher ($139,826 vs. $93,919, p < 0.01). Conclusions: Although previous studies have demonstrated lower long-term complication rates with leadless pacemakers than transvenous pacemakers, our analysis shows a higher risk of short-term in-hospital complications in ESRD patients, though no differences in in-hospital mortality and 30-day readmissions.

Analysis of the performance and pacing strategies in the 800 m for junior male athletes in the Taiwan middle school athletic games (2022-2024)

Analysis of the performance and pacing strategies in the 800 m for junior male athletes in the Taiwan middle school athletic games (2022-2024)

Analysis of the performance and pacing strategies in the 800 m for junior female athletes in the Taiwan middle school athletic games (2022-2024)

Analysis of the performance and pacing strategies in the 800 m for junior female athletes in the Taiwan middle school athletic games (2022-2024)

Technical Stroke Regulations Discriminate Pacing Effectiveness During a 5-km Indoor Pool Race.

To investigate technical regulation mechanisms of long-distance swimmers that differentiate optimal pacing strategies and the underlying kinematic parameters. Twenty-one national and international swimmers wereequipped with a sacrum-worn inertial measurement unit performed during 5000-m indoor French championships. Percentage of critical swimming speed (CSS), stroke rate, stroke length, jerk cost, stroke index, and mechanical proficiency score were computed by lap. Athletes were divided into groups of pacing effectiveness based on optimal potential performance level (OPPL)-optimal (nearOPPL) and suboptimal (farOPPL)-using functional clustering of percentage of the CSS. Race sections were analyzed with a change-in-slope detection method. Common stroke-regulation abilities and deviations by pacing groups were profiled by fitting hierarchical generalized additive models between mechanical variables and laps. The 2 clusters were discriminated by percentage of the CSS sustainment (P < .01). Optimal performers showed a +41.4% more stable pacing (2 race sections vs 3 for farOPPL) and a +36.7% higher endspurt, with a trend combining higher overall stroke rate (P = .08) with lower jerk cost (P = .17). Functional profiles showed that maintaining a higher stroke length and stroke index in a fatigued state, rather than overall values, allows the swinner to reach OPPL (P < .001). High regulation of mechanical proficiency score across the race, in line with pacing expectations of particular race sections, is a gamechanger to sustain CSS (P < .001). Specific profiles of stroke regulations, regarding tradeoff between stroke smoothness and resultant speed, lead to optimal pacing during the5000-m. The results of this study enhance the technical understanding of optimal pacing in long-distance pool races for coaches and swimmers.

Analysis of 800 m results and pacing strategies for male athletes in the Japan junior high school championships (2021-2024)

Analysis of 800 m results and pacing strategies for male athletes in the Japan junior high school championships (2021-2024)

Analysis of 800 m results and pacing strategies for female athletes in the Japan Junior High School championships (2021-2024)

Analysis of 800 m results and pacing strategies for female athletes in the Japan Junior High School championships (2021-2024)

Revamping Pace Distribution: A Case Study on Elevating the Men's 400 m Track and Field Japanese National Record After 32 Years.

Chiba, Y, Sato, K, Yoshimoto, T, Ohnuma, H, Yamanaka, R, Takahashi, K, Kobayashi, K, Matsubayashi, T, and Takai, Y. Revamping pace distribution: A case study on elevating the men's 400 m track and field Japanese national record after 32 years. J Strength Cond Res XX(X): 000-000, 2024-Many studies have investigated the 400-m sprint, and the optimal pacing strategy is subject to debate. Little information is available regarding the effects of changes in the pacing strategy on running speed and spatiotemporal variables in the official 400-m race. This case study analyzed changes in running speed and spatiotemporal variables of a Japanese elite long sprinter who set a new Japanese national record in the 400-m race by modifying his pace distribution based on the analysis of his previous races and the performances of world-class long sprinters. To revamp his pace distribution, 25 preceding races (ranging from 45.47 to 46.95 seconds) were analyzed, spanning from June 2015 to June 2023. The independent variables were the 50-m split time, average running speed, percentage of the 50-m split time relative to the 400-m record, step length, and step frequency. K.S. broke his own record by modifying the pacing distribution based on the development of his previous race and the world-class long sprinters. The modified pacing strategy increased running speed in the 200- to 300-m section. Step lengths were longer throughout the 400 m, and step frequencies were higher in the last 200 m than before the alteration in the pace distribution. Modifying the pacing strategy from leading to driving may enhance the personal records of long sprinters. This improvement is attributed to the maintenance of longer step lengths over the entire 400-m range and an increase in the step frequency in the last 200 m.

Comparative Pacing Profile and Chronometric Performance in Elite Swimmers with Intellectual Impairments and Able-Bodied Athletes.

Pacing strategy is a complex self-regulation process, crucial for optimising sports performance. Athletes with Intellectual Impairments (IIs) face unique challenges due to cognitive limitations that may hinder their ability to pace effectively, impacting chronometric performance. This study analysed the pacing profiles and chronometric performance across 253 event entries by elite swimmers with II, divided into three groups: 100 entries for group II1 (intellectual disability), 85 for group II2 (Down syndrome), and 68 for group II3 (autism spectrum disorder). These results were compared with 112 event entries from athletes without disabilities (AWDs). Data were collected from the 2023 Virtus Global Games and the 2023 World Aquatics Championships, focusing on middle-distance and long-distance events. Performance metrics were assessed using 50 m split times, and within-group variability was evaluated through coefficients of variation. Swimmers with IIs showed slower overall chronometric performance than AWDs, with the largest deficits observed in II2 athletes. The II1 and II3 groups displayed more comparable results, with the II1 group outperforming the others slightly. Despite the slower times, pacing profiles were largely similar across all groups, following a parabolic pacing strategy, especially for longer distances. Greater within-group variability in both chronometric performance and pacing profiles was observed in II2 and II3 athletes, reflecting higher functional heterogeneity. In contrast, II1 athletes, and even more so AWDs, exhibited more consistent performance and pacing across all events. While swimmers with II recorded slower times, their pacing strategies resembled those of AWDs, suggesting that cognitive limitations may not significantly impair pacing regulation in swimming. However, the higher variability in II2 and II3 athletes highlights the potential need for revised classification systems to ensure fair competition.

Spatial ventricular gradient is associated with pacing-induced cardiomyopathy.

Pacing-induced cardiomyopathy (PICM) is a frequent complication of right ventricular pacing that often requires reoperation for biventricular or conduction system pacing. Better methods for predicting PICM may inform initial pacing strategy and follow-up monitoring. The purpose of this study was to determine whether the spatial ventricular gradient (SVG), a vectorcardiographic marker of ventricular electrical and mechanical heterogeneity, is associated with the subsequent development of PICM. This was a retrospective study of patients with pacemakers implanted between 2003 and 2012 at the Hospital of the University of Pennsylvania. Baseline demographic, echocardiographic, and electrocardiographic parameters, including SVG magnitude, elevation, and azimuth, were measured from standard 12-lead electrocardiograms. Adjusted Cox proportional hazards modeling was used to assess the associations between the SVG and the risk of PICM over follow-up. Of the 203 patients with a median age of 74 years (54% male; median baseline left ventricular ejection fraction 65%), 44 (22%) developed PICM during follow-up. In unadjusted Cox regression, male sex, native QRS duration in patients without bundle branch block, and both native and paced mean adjusted SVG azimuth predicted future PICM. After multivariable adjustment, higher tertile (tertile 3 vs tertiles 1-2) of the mean adjusted SVG azimuth before (adjusted hazard ratio 1.95; P = .047) and immediately after (adjusted hazard ratio 2.55; P=.003) pacemaker implantation remained significant predictors of PICM. Assessment of the SVG both before and immediately after pacemaker implantation can help identify patients at elevated risk of PICM and may identify a cohort of patients who would be better served with initial biventricular or conduction system pacing.

Left bundle branch block-Innocent bystander, silent menace, or both.

Left bundle branch block (LBBB) causes immediate electrical and mechanical dyssynchrony of the left ventricle (LV) and gradual structural damages in the Purkinje cells and myocardium. Mechanical dyssynchrony reduces the LV ejection fraction (EF) instantly, but only to ≈55% in an otherwise normal heart. Because of the heart's in-built functional redundancy, a patient with LBBB does not always notice the heart's reduced efficiency straightaway. After a variable period of time (which could be from days to decades), the patient may become symptomatic with heart failure (HF), which classifies as HF with preserved EF ≥50% (HFpEF). The LVEF drops further because of continuous adverse remodeling and inefficient cardiac contraction. The patient transits to HF with moderately reduced EF 35%-50% (HFmrEF) and then reduced EF ≤35% (HFrEF) over 5-21 years. Cardiac resynchronization therapy (CRT) is currently only indicated in guidelines for HFrEF and LBBB. LBBB shortens the median survival of patients with HFmrEF by 5.5 years. Randomized controlled trials have shown that CRT improves echocardiographic indices for HFmrEF with LBBB. CRT in HFpEF with LBBB is a promising but underexplored/underused therapy. There have been anecdotal reports that CRT produced symptom relief in patients debilitated by HFpEF with LBBB, who constitute ≈6% of all patients with HF and an adequate pool of potential randomized controlled trial participants. Conduction system pacing in the form of left bundle branch area pacing is an emerging pacing strategy that might reverse and forestall the deleterious effects of LBBB.

Pacing strategies of 10 km elite open water swimmers with enhanced temporal resolution: World Swimming Championships Budapest 2022

ABSTRACT The pacing and tactical race strategies of open water (OW) swimmers have been recognized as significant performance determinants in these events, despite the limited resolution of available race data due to the aquatic environment constraints. The main objective of the study was to re-examine the pacing strategies and race tactics of elite OW swimmers from new enhanced temporal resolution data during the 2022 World Championships (WCH). Data were collected from 58 males and 58 females participants classified into 5 performance groups (G1-G5) depending on their finishing positions. Average velocity, stroke rate, and partial positions were obtained for each swimmer in 17 timing points over the 10 km race (on average 550 m or 5.5% of the race distance). The pacing strategies of successful swimmers, especially men, showed a less conservative behaviour than previous WCH with leading race positions (at least top-6) from the race early stages and a lower race density (≈2%) upon arrival. The enhanced temporal resolution race data showed greater pacing variations as well as end race spurts over a shorter distance than previously reported for successful competitors. These results describe a partly new paradigm in OW race strategies compared to previous race data with low temporal resolution.

Differences in 5-km running pace between female and male triathletes.

During an IRONMAN, the pacing strategy in the running segment differs significantly between sexes. However, it is unknown if sex affects the running pace in shorter triathlon events. This study compared the pacing strategy between sexes during a 5-km running test performed following a 20-km cycle (sprint triathlon distances). Participants included 16 men (34.7±7.5 years) and 16 women (39.5±7.7 years). A cardiopulmonary exercise test to measure maximal oxygen uptake (˙VO2max) and a functional threshold power (FTP) were performed. Body composition was measured using a dual-emission X-ray absorptiometry system. Participants cycled at 90% FTP for 20 km and ran as fast as possible for 5 km. The total time spent cycling 20 km was shorter (~11%) in male than in female athletes (p<0.001). Similarly, the time spent to run 5 km was shorter in male (~11%) than in female athletes (p=0.006). Male athletes performed the last 600 m of the 5km race significantly faster than the initial meters (p<0.05). Female athletes performed the 5-km race without pace variation (p>0.05). In conclusion, apart from the sex differences associated with performance in short-term triathlon events, the pacing strategy was also different.

Pacing analysis and comparison of TOP-10 and NOT TOP-10 Ultra Trail Cape Town 100-km finishers.

Pacing strategies during endurance efforts vary depending on athlete experience, race length, and terrain. In ultramarathon trail running the specific race route profile can have a significant impact on optimal pacing strategy. The aim of this study was to determine the relationship between uphill, downhill and level running with overall performance and to compare the difference in pacing strategies between top 10 (TOP-10) and non-top 10 (NOT TOP-10) finishers of a 100-km ultra-trail marathon with +5000-m elevation gain. Fifty male finishers (TOP-10: N.=6, NOT TOP-10, N.=44) and forty-six individual segments (1.5±1.2 km) were analyzed based on 2021 100-km UTCT STRAVA data. Relative segment speed and CV% were used to identify pacing strategies. Spearman Rank and Mann Whitney-U tests were used to analyze the data. Significance was set at P<0.05. Uphill running had the strongest relationship with overall performance (r=0.826, P<0.01). Substantially weaker relationships between overall running performance and level (r=0.402, P<0.01) and downhill (r=-0.382, P<0.01) running performance were found. The CV% was significantly lower in TOP-10 (32.10±1.81) than NOT TOP-10 (35.39±4.43) (U=24, r=0.46, P<0.01). Uphill running performance remains a valuable measure of overall trail running performance as it represents a higher percentage of overall running demand. TOP-10 runners have diminished decay in initial running speed than NOT TOP-10 runners, despite a generally high variation in pace and net positive split in ultra-trail running.

Powering Toward Los Angeles: Comparing Power Output and Pacing Approach Between Maximal 2000- and 1500-m On-Water Racing in Elite Rowers.

To compare power output and pacing between maximal 1500- and 2000-m on-water rowing performances. Twenty-six (female n = 4, male n = 22) international rowers, across 6 boat classes, completed maximal 1500- and 2000-m on-water races, separated by 24 to 48hours. Crew combinations and seat orders remained consistent between races. Peach PowerLine instrumentation measured power output and stroke rate. Differences in completion time, mean power output (MPO), percentage prognostic velocity (PPV;percentage of world record velocity in each boat class), stroke rate, and pacing variance were assessed using linear mixed modeling. Compared with 2000-m, completion times were 90.4 (6.1) seconds shorter over 1500m (-24.7% [0.7%]). Both MPO (P = .255, ηp2=.06) and PPV (P = .340, ηp2=.18) were not different between distances. Broadly, crews adopted a reverse-J-shaped pacing across both distances, demonstrating a reduced variance over 1500m (P = .035, ηp2=.62). Percentage change in MPO from 2000 to 1500m demonstrated a strong negative association with pacing variance over 1500m (R2 = .74, P = .027). International rowing crews did not increase MPO or PPV when racing maximally over 1500m compared to 2000m. Comparable strategies were adopted over both distances, with less variance in pacing observed over 1500m. The crews that demonstrated greater increases in MPO over the shorter race employed a flatter pacing strategy. To improve 1500-m on-water performance, rowers may need to adopt a more even pacing approach.

The variability of competitive performance and pacing strategies in different rounds of the 400 m and 800 m freestyle swimming races at the 2017-2024 World Swimming Championships.

This study aims to analyze the competitive performance and pacing strategies (PS) of medalists and non-medalists in different rounds of the 400 m and 800 m freestyle at the World Swimming Championships. The 2017-2024 World Swimming Championships and 161 elite swimmers were selected. First, intra-athlete coefficients of variability (CVs) were evaluated using linear mixed effects modeling and changes in competitive performance (Δ); second, descriptive statistics of position lap time; finally, a computer algorithm was used to obtain PS, then a two-way ANOVA was performed. (i) The PS was effective in 87.5% of the swimmers in the finals compared to the heats (CVs > 0.5%), but 73.8% of the males and 86.8% of the females showed an improvement in performance prior to the finals (Δ < 0); (ii) Gold medalists had an average position no lower than the top 2 and established themselves in the top 3 positions more than 90% of the time, aiming to remain in the top 3 until the final 100 m if they were to win a medal; (iii) The female swimmers in 400 m were more in the heats utilize the inverted-J (race velocity change curve profile as inverted-J), men for the fast-start-even, in the final, female remain the inverted-J, men change to the U-shaped (race velocity change curve profile as U-shaped), and in the 800 m, the swimmers were unified adopt the U-shaped. The elite swimmers who qualified for the finals performed better in the heats and semifinals because their PS were more effective. Others, however, did not have a chance to reach the finals because their PS efficiency was lower, and their competitive performance improved less or even regressed.

Conduction-System pacing Italian Network Group (C-SING): insights from a Nationwide Multicenter Observational Study

Abstract Background/Introduction Conduction system pacing (CSP), encompassing His bundle pacing (HBP) and left bundle branch area pacing (LBBAP), has gained prominence in treating bradycardia and heart failure in recent years. Despite its increasing utilization, data on real-world adoption of CSP are limited. Purpose The C-SING study aimed at assessing patient characteristics, implant success, procedural details, and safety of CSP when performed in routine clinical practice. Methods Periprocedural data from 27 experienced CSP centers across Italy were collected on patients undergoing CSP implantation for various indications between January 2021 and January 2024. Results The study comprised 1,317 patients (median age 78 years [interquartile range, 71-83], male 66.2%). Leading indications included atrioventricular (AV) block (40.8%), sinus node dysfunction (12.1%), atrial fibrillation with bradycardia (9.7%), AV node ablation (9.5%), and heart failure (12.5%). Pacemakers were implanted in 77.3% of patients, cardiac resynchronization devices in 21.7%, and implantable cardioverter-defibrillators in 1.0%. Stylet-driven and lumenless CSP leads were utilized in 64.7% and 35.3% of procedures, respectively. Final 12-lead ECG assessment revealed LBBAP capture in 88.7% patients, HBP in 8.4% (selective 4.2%, non-selective 4.2%), and no CSP capture in 3.0%, resulting in a 97.0% CSP lead implantation success rate. In patients with LBBAP, predominant capture types were left bundle branch pacing (19.6%), left posterior fascicular pacing (19.2%), and left septal fascicular pacing (14.8%). Comparing HBP to LBBAP, the latter showed shorter procedural time (60 minutes [45-80] vs. 70 minutes [60-95], p=0.003), but similar fluoroscopy time (6.0 minutes [3.3-10.8] vs. 6.1 minutes [4-10], p=0.735). Paced QRS duration was longer in LBBAP (118 ms [105-130]) compared to HBP (110 ms [101-122], p&amp;lt;0.001). LBBAP showed lower capture thresholds (0.6 V [0.5-0.9] @0.4 ms vs. 0.8 V [0.5-1.5] @1.0 ms, p&amp;lt;0.001) and higher R-wave sensing (10.7 mV [8-16] vs. 4.5 mV [2.4-9.9], p&amp;lt;0.001). The rate of periprocedural complications was higher in patients with LBBAP than HBP (7.3% vs. 1.8%, p=0.03), with the most frequent events being intraprocedural perforation into the left ventricular cavity during lead screwing (2.6%) and CSP lead dislodgment before hospital discharge (1.4%). These occurrences necessitated lead repositioning without additional complications. Conclusion CSP demonstrated feasibility as a primary pacing strategy for various indications in a real-world, multicenter setting. LBBAP, more frequently used than HBP, exhibited shorter procedural time and superior acute electrical parameters. LBBAP revealed a higher rate of minor procedural complications than HBP. Further investigations, supported by additional long-term outcome data, are essential to comprehensively assess CSP performance.