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Related Experiment Video

Updated: Jul 9, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

Conduction-System Versus Biventricular Pacing for CRT in HFrEF: Pairwise and Network Meta-Analysis.

Mustafa Abomohsen¹, Mohamed Rifai², Azad Mojahedi¹

¹Cardiology Department, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA.

Pacing and Clinical Electrophysiology : PACE

|July 8, 2026

Summary

Conduction-system pacing (CSP) did not show superiority over biventricular pacing (BiVP) for improving ejection fraction, hospitalizations, or mortality in heart failure patients. While CSP offers a feasible alternative, BiVP remains the standard approach.

Keywords:

Cardiac resynchronization therapy His‐bundle pacing biventricular pacing conduction‐system pacing heart failure with reduced ejection fraction left bundle branch area pacing network meta‐analysis randomized controlled trial

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Area of Science:

Cardiology
Electrophysiology
Heart Failure Management

Background:

Conduction-system pacing (CSP) is a physiological alternative to biventricular pacing (BiVP) for cardiac resynchronization therapy (CRT) in heart failure with reduced ejection fraction (HFrEF).
Uncertainty exists regarding CSP's comparative efficacy and safety versus BiVP.

Purpose of the Study:

To systematically compare the clinical, echocardiographic, procedural, and safety outcomes of CSP versus BiVP in HFrEF patients undergoing CRT.
To evaluate the superiority of different CSP modalities against BiVP through network meta-analysis.

Main Methods:

Systematic review and meta-analysis (pairwise and network) of randomized controlled trials comparing CSP and BiVP in HFrEF.
Inclusion of PubMed/MEDLINE, Embase, Scopus, Web of Science, and CENTRAL databases up to May 2026.
Primary outcomes: change in left ventricular ejection fraction (LVEF), heart-failure hospitalization, all-cause mortality. Secondary outcomes included functional class, QRS duration, ventricular volumes, and safety metrics.

Main Results:

Nine trials with 976 participants showed CSP was not significantly superior to BiVP for LVEF improvement, heart-failure hospitalization, or all-cause mortality.
Network meta-analysis revealed no significant advantage of individual CSP strategies over BiVP for primary outcomes.
CSP showed a modest improvement in NYHA functional class but no significant differences in other secondary outcomes like QRS duration, ventricular volumes, or safety.

Conclusions:

Randomized evidence indicates CSP is not consistently superior to BiVP for key outcomes in HFrEF patients undergoing CRT.
CSP is a feasible physiological alternative for selected patients in experienced centers, but BiVP remains the default.
Larger trials with standardized criteria and longer follow-up are necessary to fully elucidate CSP's role.