Conduction System Pacing Versus Biventricular Cardiac Resynchronization Pacing: Meta-Analysis on Outcomes in Patients
Xuanming Pung1, Joe J L Chua1, Khi Yung Fong2
1Department of Cardiology, National Heart Centre Singapore, Singapore 169609, Singapore.
Medicina (Kaunas, Lithuania)
|July 30, 2025
Summary
Conduction system pacing (CSP) shows improved electrical synchrony and echocardiographic response compared to biventricular pacing (BVP) in heart failure with reduced ejection fraction patients without left bundle branch block. Clinical outcomes were similar between the two pacing methods.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Biventricular pacing (BVP) efficacy is less defined in heart failure with reduced ejection fraction (HFrEF) without left bundle branch block (LBBB).
- Conduction system pacing (CSP) offers a potentially more physiological alternative to BVP.
- Existing studies comparing CSP and BVP in this population have yielded conflicting results.
Purpose of the Study:
- To compare procedural and clinical outcomes between CSP and BVP in HFrEF patients without LBBB.
- To evaluate the effectiveness of CSP versus BVP in improving electrical synchrony and cardiac function.
Main Methods:
- Systematic literature search for studies comparing CSP and BVP in HFrEF patients with non-LBBB.
- Inclusion of four studies involving 461 patients.
- Meta-analysis of procedural and clinical outcomes.
Main Results:
- CSP resulted in a significantly shorter paced QRS duration (mean difference -19.7 ms).
- CSP demonstrated a significantly greater improvement in left ventricular ejection fraction (mean difference 5.6%).
- No significant differences were observed in all-cause mortality or heart failure hospitalizations.
Conclusions:
- CSP may offer superior electrical synchrony and echocardiographic response compared to BVP in HFrEF patients without LBBB.
- Further randomized controlled trials with extended follow-up are needed to confirm benefits in clinical outcomes.
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