Heart failure & cardiomyopathiesMeta-analysis
Conduction system pacing vs biventricular pacing for cardiac resynchronization therapy: Frequentist and Bayesian meta-analysis of randomized controlled trials and propensity-matched studies
- Frequentist and Bayesian meta-analysis of randomized controlled trials and propensity-matched studies
- systematic searching of databases
Authors' conclusion
CSP may offer potential advantages over BiV pacing in patients indicated for CRT; however, confirmation in larger randomized clinical trials is required.
Study context
- Population
- Patients indicated for cardiac resynchronization therapy (CRT)28 studies (13 randomized controlled trials (RCTs))
- Participants
- 5,524 patients
- Comparison
- conduction system pacing with biventricular (BiV)
Pooled result
CRT response
Odds ratio
1.69
95% CI 1.20–2.39
P = 0.0027
CSP vs BiV
OR 1.69 (95% CI 1.20–2.39); P = 0.0027
As reported in the abstract
Further pooled results
| Outcome | OR (CI) | P value | |
|---|---|---|---|
| Clinical response | 1.83 (1.12–2.99) | P = 0.01 | |
| Composite outcomes | 0.51 (0.30–0.88) | P = 0.01 | |
| HF hospitalization | 0.58 (0.35–0.96) | P = 0.0347 | |
| All-cause mortality | 0.67 (0.46–0.97) | P = 0.0340 | |
| 0.20.5125Odds ratio (log scale) |
QRS duration, left ventricular ejection fraction, left ventricular end-systolic diameter, N-terminal pro-B-type natriuretic peptide, New York Heart Association, and 6MWD
- Significantly higher improvement with conduction system pacing (CSP)
- all P < .05
Bayesian meta-analysis
- Consistently favored CSP across all clinical outcomes; probability of meaningful benefit exceeding 90% for CRT response, super-response, composite outcome, and heart failure (HF) hospitalization
- 90%
RCT-only analysis
- Inconsistent results across most outcomes, with only clinical response remaining statistically significant
Subgroup analyses
- Left bundle branch pacing (LBBP) appears to have the most benefit across CRT response and HF hospitalization outcomes
Original publication
Conduction system pacing vs biventricular pacing for cardiac resynchronization therapy: Frequentist and Bayesian meta-analysis of randomized controlled trials and propensity-matched studies. Heart Rhythm. Published 4 July 2026. doi:10.1016/j.hrthm.2026.07.001
Summarised from the published abstract; every number is checked against it