Journal of arrhythmia
Conduction System Pacing Versus Biventricular Pacing for Cardiac Resynchronization Therapy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
By Singireddy S, Shoura S, Venugopal D and 4 others.
Abstract
Background
Conduction system pacing (CSP) is an emerging alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT). Recent randomized controlled trials (RCTs) have yielded divergent results, creating uncertainty about the comparative effectiveness.
Methods
We performed a systematic review and meta-analysis of RCTs comparing CSP with BVP for CRT, searching PubMed, Embase, and CENTRAL through May 2026 (updating a prior review). The primary outcome was change in left ventricular ejection fraction (ΔLVEF), analyzed with random-effects models and prediction intervals.
Results
Eight parallel-group RCTs including 799 patients (396 CSP, 403 BVP) were included. Pooled ΔLVEF did not differ significantly (MD +2.40%, 95% CI -0.49 to 5.29, p = 0.091; I 2 = 75%). CSP showed a non-significant trend toward shorter paced QRS (MD -7.6 ms, p = 0.14) and improved NYHA class (SMD -0.33, p = 0.12). Heart failure hospitalization (RR 0.69), mortality (RR 1.17), complications (RR 0.84), and procedure time did not differ. The four trials enrolling exclusively LBBB patients favored CSP (MD +5.00%, 95% CI 3.01 to 6.98, p = 0.004; I 2 = 0%), consistent in the three using confirmed LBBAP/LBBP (MD +5.37%, 95% CI 3.23 to 7.52, p = 0.008; I 2 = 0%).