Conduction system pacing compared with biventricular pacing for cardiac resynchronization therapy: a systematic...

Area of Science:

• Cardiology
• Medical Technology
• Clinical Research

Background:

• Conduction system pacing (CSP) offers a physiological alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT).
• Patients with heart failure and reduced ejection fraction (HFrEF) are candidates for CRT.

Purpose of the Study:

• To systematically compare the clinical efficacy and safety of CSP versus BVP in HFrEF patients.
• To synthesize the latest evidence through a meta-analysis.

Main Methods:

• A systematic search of major databases (PubMed, Embase, Web of Science, Cochrane Library) was conducted.
• Included studies were RCTs and observational studies comparing CSP and BVP in adult HF patients with LVEF ≤ 50%.
• Primary outcomes included LVEF, NYHA class, QRS duration, HF hospitalization, and all-cause mortality.

Main Results:

• CSP demonstrated greater improvements in LVEF, NYHA class, and QRS narrowing compared to BVP.
• CSP significantly reduced heart failure hospitalizations and echocardiographic non-response rates.
• All-cause mortality was comparable, while CSP showed shorter fluoroscopy times with similar complication rates.

Conclusions:

• CSP may offer superior echocardiographic and electrocardiographic outcomes compared to BVP.
• The current evidence certainty is low to very low, requiring large-scale RCTs for validation.
• Findings are hypothesis-generating, emphasizing the need for further research before widespread CSP adoption.