Conduction System Pacing Versus Biventricular Pacing for Cardiac Resynchronization Therapy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
- 1Division of Cardiology, Department of Internal Medicine University of Illinois College of Medicine at Peoria Peoria Illinois USA.
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%).Conclusions
In this analysis of randomized trials of CRT, no statistically significant difference was observed between CSP and BVP for any outcome. Because no non-inferiority margin was prespecified and the clinical-event analyses were underpowered, these findings should not be interpreted as establishing equivalence or comparable safety. Exploratory analyses suggest that patients with LBBB undergoing LBBAP/LBBP may derive incremental benefit, warranting confirmation in adequately powered trials.
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BibTeX
@article{singireddy2026conduction,
title = {{Conduction System Pacing Versus Biventricular Pacing for Cardiac Resynchronization Therapy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.}},
author = {Shreyas Singireddy and Sami Shoura and Darshine Venugopal and Ragavendar Saravanabavanandan and Kyle Coombes and Timir Baman and Siddharth Shah},
journal = {Journal of arrhythmia},
year = {2026},
month = oct,
doi = {10.1002/joa3.70500},
url = {https://europepmc.org/article/MED/42909950},
note = {CC BY},
}
RIS
TY - JOUR
TI - Conduction System Pacing Versus Biventricular Pacing for Cardiac Resynchronization Therapy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
AU - Shreyas Singireddy
AU - Sami Shoura
AU - Darshine Venugopal
AU - Ragavendar Saravanabavanandan
AU - Kyle Coombes
AU - Timir Baman
AU - Siddharth Shah
PY - 2026
DA - 2026/10/21
JO - Journal of arrhythmia
DO - 10.1002/joa3.70500
UR - https://europepmc.org/article/MED/42909950
AB - 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%).Conclusions In this analysis of randomized trials of CRT, no statistically significant difference was observed between CSP and BVP for any outcome. Because no non-inferiority margin was prespecified and the clinical-event analyses were underpowered, these findings should not be interpreted as establishing equivalence or comparable safety. Exploratory analyses suggest that patients with LBBB undergoing LBBAP/LBBP may derive incremental benefit, warranting confirmation in adequately powered trials.
SN - 1880-4276
SN - 1883-2148
ER -