Conduction system pacing for cardiac resynchronization therapy: a systematic review
Why the study?
Does conduction system pacing improve CRT outcomes compared with biventricular pacing in patients with heart failure and LBBB?
Comparison
CSP (His bundle pacing and left bundle branch area pacing) vs BVP
Design
Systematic review
Authors
Discussion
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Member takes
Implication
CSP should not yet replace BVP as first-line CRT; leaves open whether superior synchrony improves outcomes pending large RCTs.
Structured PICO
Does conduction system pacing improve CRT outcomes compared with biventricular pacing in patients with heart failure and LBBB?
P
Population
Patients with heart failure and left bundle branch block (LBBB)
I
Intervention
Conduction system pacing (CSP), including His bundle pacing and left bundle branch area pacing
C
Comparator
Biventricular pacing (BVP)
O
Outcome
Electro-mechanical ventricular synchrony and CRT outcomes
Conduction system pacing is a promising physiological alternative to biventricular pacing for CRT, but lacks sufficient large-scale RCT data to replace it as the first-line strategy.
Limitations
- evidence from large-scale randomized controlled trials remains scarce
- challenges related to procedural complexity
- insufficient long-term outcome data
Cite This Study
Fotos et al. (2026) studied this question.