Related Experiment Video
Updated: Jul 2, 2025
Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
Conduction system pacing versus biventricular pacing in heart failure with reduced ejection fraction: A systematic
Iuri Ferreira Felix1, Michelle Collini2, Rafaela Fonseca3
1Department of Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota.
Insights
Conduction system pacing (CSP) offers significant benefits over biventricular pacing (BVP) for heart failure with reduced ejection fraction (HFrEF) patients needing cardiac resynchronization. CSP improves QRS duration, NYHA functional class, and ejection fraction, suggesting it
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Conduction system pacing (CSP) is an emerging alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT).
- Patients with heart failure with reduced ejection fraction (HFrEF) and ventricular dyssynchrony are candidates for CRT, but CSP's comparative efficacy remains under investigation.
Purpose of the Study:
- To evaluate and compare the clinical outcomes of CSP versus BVP for cardiac resynchronization in patients diagnosed with HFrEF.
- To synthesize evidence from randomized controlled trials (RCTs) to determine the relative benefits and drawbacks of each pacing strategy.
Main Methods:
- A systematic review and meta-analysis of RCTs comparing CSP and BVP for CRT in HFrEF patients.
- Searches were conducted across PubMed, Scopus, and Cochrane databases.
- Data were analyzed using a random-effects model, with heterogeneity assessed via I² statistics.
Main Results:
- CSP demonstrated a significantly greater reduction in QRS duration (MD -13.34 ms) and improved New York Heart Association (NYHA) functional class (SMD -0.37) compared to BVP.
- Left ventricular ejection fraction (LVEF) significantly increased with CSP (MD 2.06%).
- No significant differences were observed in left ventricular end-systolic volume, lead capture threshold, or procedure time.
Conclusions:
- Conduction system pacing may offer superior electrocardiographic, echocardiographic, and symptomatic benefits compared to biventricular pacing for HFrEF patients requiring cardiac resynchronization.
- CSP represents a potentially more effective CRT strategy, warranting further investigation and consideration in clinical practice.
Abstract:
Conduction system pacing (CSP) has emerged as a promising alternative to biventricular pacing (BVP) in patients with heart failure with reduced ejection fraction (HFrEF) and ventricular dyssynchrony, but its benefits are uncertain. In this study, we aimed to evaluate clinical outcomes of CSP vs BVP for cardiac resynchronization in patients with HFrEF. PubMed, Scopus, and Cochrane databases were searched for randomized controlled trials comparing CSP to BVP for resynchronization therapy in patients with HFrEF. Heterogeneity was examined with I2 statistics. A random-effects model was used for all outcomes. We included 7 randomized controlled trials with 408 patients, of whom 200 (49%) underwent CSP. Compared to BVP, CSP resulted in a significantly greater reduction in QRS duration (MD -13.34 ms; 95% confidence interval [CI] -24.32 to -2.36, P = .02; I2 = 91%) and New York Heart Association functional class (standardized mean difference [SMD] -0.37; 95% CI -0.69 to -0.05; P = .02; I2 = 41%), and a significant increase in left ventricular ejection fraction (mean difference [MD] 2.06%; 95% CI 0.16 to 3.97; P = .03; I2 = 0%). No statistical difference was noted for left ventricular end-systolic volume (SMD -0.51 mL; 95% CI -1.26 to 0.24; P = .18; I2 = 83%), lead capture threshold (MD -0.08 V; 95% CI -0.42 to 0.27; P = .66; I2 = 66%), and procedure time (MD 5.99 minutes; 95% CI -15.91 to 27.89; P = .59; I2 = 79%). These findings suggest that CSP may have electrocardiographic, echocardiographic, and symptomatic benefits over BVP for patients with HFrEF requiring cardiac resynchronization.
More Related Videos
12:45Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
09:20Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Related Concept Videos
01:22Heart Failure Drugs: β-Blockers
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:17Pathophysiology of Heart Failure
01:19Conduction System of the Heart
The pacemaker cells are located in two primary nodes: the sinoatrial (SA) node and the atrioventricular (AV) node. The SA node pacemaker cells can autonomously depolarize, triggering an action potential that leads to the...