Key result
CSP shortens paced QRS by ~20 ms and improves LVEF vs BiVP in non-LBBB HFrEF.
Why the study?
The role of biventricular pacing is less well-established in HFrEF without left bundle branch block, and small studies comparing it with conduction system pacing have reported conflicting results.
Does conduction system pacing improve procedural and clinical outcomes compared to biventricular pacing in patients with HFrEF and non-LBBB?
Comparison
Conduction system pacing vs biventricular pacing
Design
Systematic review and meta-analysis
Authors
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May favor conduction system pacing for better response in non-LBBB HFrEF; extends surrogate evidence but leaves clinical outcomes uncertain.
Meta-Analysis (n=461)
Does conduction system pacing improve procedural and clinical outcomes compared to biventricular pacing in patients with HFrEF and non-LBBB?
Effect estimate: MD -19.7 ms (95% CI -36.2 to -3.3)
p-value: p=0.0355
In HFrEF patients with non-LBBB, conduction system pacing improves electrical synchrony and LVEF compared to biventricular pacing, though clinical outcome benefits remain uncertain.
Pung et al. (2025) conducted a meta-analysis in Heart failure with reduced ejection fraction (HFrEF) without left bundle branch block (LBBB) (n=461). Conduction system pacing (CSP) vs. Biventricular pacing (BVP) was evaluated on Implant-derived paced QRS duration (MD -19.7 ms, 95% CI -36.2 to -3.3, p=0.0355). Conduction system pacing significantly shortened paced QRS duration (MD -19.7 ms; 95% CI -36.2 to -3.3; p=0.0355) and improved LVEF compared to biventricular pacing in HFrEF patients with non-LBBB.
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