Related Experiment Video
Updated: Jul 9, 2026
12:45
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.
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.
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