Key result
In a review of 2841 patients, conduction system pacing yielded better outcomes than biventricular pacing, resulting in fewer heart failure hospitalizations and lower all-cause mortality.
Why the study?
Around 30% of heart failure patients do not achieve desired clinical outcomes with traditional biventricular pacing, prompting the review of more physiologic conduction system pacing techniques for cardiac resynchronization therapy.
Does conduction system pacing improve clinical and echocardiographic outcomes compared to biventricular pacing in patients with heart failure with reduced ejection fraction?
Does conduction system pacing improve clinical and echocardiographic outcomes compared to biventricular pacing in patients with heart failure with reduced ejection fraction?
Conduction system pacing, particularly left bundle branch area pacing, may offer superior clinical and echocardiographic outcomes compared to traditional biventricular pacing for cardiac resynchronization therapy in HFrEF.
May support conduction system pacing evaluation in HFrEF; leaves open randomized confirmation before practice change.
Most patients with heart failure exhibit ventricular dyssynchrony, which is addressed by cardiac resynchronization therapy, traditionally through the use of biventricular pacing (BVP) devices. Despite this, around 30% of patients do not achieve the desired clinical outcome, and echocardiographic findings show that some patients deteriorate even further. Conduction system pacing (CSP) is a more physiologic pacing technique and includes his-bundle pacing (HBP) and left bundle branch area pacing (LBBAP). In this review, we further discuss and compare various CSP techniques for cardiac resynchronization therapy in patients with heart failure with reduced ejection fraction. After analyzing the current state of the literature on this topic until 2023, eight studies were included in this review and consisted of two trials and five observational studies with a total of 2841 patients. Both BVP and CSP resulted in improved outcomes in terms of NYHA class, QRS duration, and left ventricular ejection fraction over time. These effects were more pronounced in patients undergoing CSP, as the technique is more physiological and results in the synchronized activation of the ventricles. LBBAP yielded better outcomes compared to BVP and resulted in fewer heart failure hospitalizations and a lower all-cause mortality rate.
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Karki et al. (2025) conducted a review in Heart failure with reduced ejection fraction (n=2,841). Conduction system pacing (CSP) vs. Biventricular pacing (BVP) was evaluated on NYHA class, QRS duration, left ventricular ejection fraction, heart failure hospitalizations, and all-cause mortality. In a review of 2841 patients, conduction system pacing yielded better outcomes than biventricular pacing, resulting in fewer heart failure hospitalizations and lower all-cause mortality.
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