{
  "abstract": "Background/Objectives: Conduction system pacing (CSP) has emerged as a more physiological alternative to biventricular pacing (BiVP) in heart failure with reduced ejection fraction (HFrEF) and wide QRS, but recent randomized controlled trials (RCTs) have yielded discordant results. This meta-analysis aimed to compare CSP with BiVP for clinical events and functional recovery in HFrEF. Methods: MEDLINE, Embase, and Cochrane Library were searched for RCTs through 15 April 2026. Primary outcomes were all-cause mortality (ACM) and heart failure hospitalization (HFH) at mid-term (6–12 months) and long-term (>12 months) follow-up. Random-effects meta-analyses and Trial Sequential Analysis (TSA) were performed. Results: Eleven RCTs comprising 12 reports and 1073 patients were included. CSP showed no significant difference in mid-term ACM (RR 0.72; 95% CI 0.21 to 2.49; p = 0.605) or HFH (RR 0.97; 95% CI 0.52 to 1.81; p = 0.918). At long-term follow-up (three RCTs; n = 312), CSP showed a non-significant trend toward ACM reduction (RR 0.34; 95% CI 0.11 to 1.06; p = 0.063; low-certainty evidence) and a significant, TSA-supported reduction in HFH (RR 0.30; 95% CI 0.16 to 0.58; p < 0.001; moderate-certainty evidence). At 6 months, CSP improved LVEF (MD 2.84%; 95% CI 0.74 to 4.93; p = 0.008) and reduced QRS duration (MD −9.97 ms; 95% CI −18.57 to −1.37; p = 0.023), with NYHA improvement at 12 months (MD −0.31; 95% CI −0.50 to −0.11; p = 0.002). Conclusions: In this meta-analysis of RCTs predominantly evaluating left bundle branch area pacing, CSP was associated with a lower risk of long-term HFH compared with BiVP in HFrEF with a wide QRS, although the evidence remains limited by the small number of available trials. The observed trend toward lower long-term ACM should be considered hypothesis-generating. Larger, adequately powered RCTs with longer follow-up are needed to confirm these findings and determine whether CSP provides sustained clinical benefit over BiVP.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Internal Medicine, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA 23507, USA",
    "Unidad de Revisiones Sistemáticas y Meta-Análisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima 15024, Peru",
    "Department of Cardiology, Bassett Medical Center, Cooperstown, NY 13326, USA",
    "Department of Cardiology, Inova Schar Heart and Vascular Institute, Falls Church, VA 22042, USA",
    "Department of Cardiology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA 23507, USA",
    "Advanced Heart Failure Center, Sentara Heart Hospital, Norfolk, VA 23507, USA",
    "Department of Medicine, Division of Cardiology, Icahn School of Medicine, Mount Sinai Fuster Heart Hospital, New York, NY 10029, USA",
    "Department of Electrophysiology, Sentara Medical Group, Sentara Health, Virginia Beach, VA 23454, USA"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Juan Munoz-Moreno",
      "orcid": "0000-0002-2838-1496"
    },
    {
      "affs": [
        1
      ],
      "name": "Carlos Diaz-Arocutipa",
      "orcid": "0000-0002-5101-2832"
    },
    {
      "affs": [
        2
      ],
      "name": "Carlos Espiche-Salazar"
    },
    {
      "affs": [
        3
      ],
      "name": "Jacob McAuliffe"
    },
    {
      "affs": [
        4
      ],
      "name": "Raymond L. Benza"
    },
    {
      "affs": [
        4,
        5
      ],
      "name": "Amin Yehya"
    },
    {
      "affs": [
        6
      ],
      "name": "Johanna Contreras"
    },
    {
      "affs": [
        4,
        7
      ],
      "name": "Erich L. Kiehl"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dh651a6nq0r1b.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15208087",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13705894/?tool=EBI",
  "id": "dh651a6nq0r1b",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/20/8087",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2705|Cardiac pacing and defibrillation studies"
    ]
  ],
  "openalex": "W7222914430",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13705894/pdf/?tool=EBI",
  "pmcid": "PMC13705894",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/dh651a6nq0r1b.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:01Z",
      "native_id": "10.3390/jcm15208087",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/20/8087"
    },
    {
      "first_seen": "2026-10-30T12:21:47Z",
      "native_id": "PMC:PMC13705894",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13705894"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Cardiac pacing and defibrillation studies",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Mid-Term and Long-Term Clinical Events with Conduction System Pacing Versus Biventricular Pacing in HFrEF with Wide QRS: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis",
  "title_text": "Mid-Term and Long-Term Clinical Events with Conduction System Pacing Versus Biventricular Pacing in HFrEF with Wide QRS: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:47Z",
  "url": "https://research.draconitic.com/paper/dh651a6nq0r1b",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}