The frequency in which His bundle pacing can correct left bundle branch block patterns in an unselected heart failure population is not known, and no prospective trials comparing BiV-CRT versus His bundle pacing in lieu of a left ventricular lead for CRT (His-CRT) have been performed to date. The His-SYNC (His Bundle Pacing versus Coronary Sinus Pacing for Cardiac Resynchronization Therapy) pilot trial was an investigator-initiated, prospective, randomized controlled trial that aimed to assess the feasibility and efficacy of His-CRT as a first-line strategy compared with BiV-CRT. Among 41 patients enrolled (64 ± 13 years of age, 38% women, LVEF 28%, 65% with coronary artery disease, QRS width 168 ± 18 ms left bundle branch block pattern = 35, right bundle branch block = 2, paced = 3), 21 were randomized to His-CRT and 20 to BiV-CRT.