Exercise Capacity Improvement by Conduction System Pacing in heArt Failure patieNts Without Compelling CRT inDication

This study is testing whether a newer pacing technique called Conduction System Pacing (CSP) — which delivers electrical signals more naturally through the heart's own wiring — improves exercise capacity and heart function compared to standard pacing in heart failure patients who need a pacemaker but do not have a strong indication for traditional cardiac resynchronization therapy (CRT). **You may be eligible if...** - You have heart failure with either reduced or mildly reduced heart pumping function - You need a pacemaker as indicated by current heart failure guidelines - You have signs or symptoms of heart failure confirmed by your doctor **You may NOT be eligible if...** - You are under 18 years old or pregnant - You have a strong guideline-based indication for traditional CRT (unless CRT lead placement failed) - You have recent heart failure hospitalization (within 4 weeks), uncontrolled arrhythmia or high blood pressure, severe valve disease, or severe vascular/orthopedic limitations to exercise testing - You have severe kidney disease (very low kidney function or on dialysis), severe COPD, or active cancer Talk to your doctor to see if this trial is right for you.