Heart failure & cardiomyopathiesMeta-analysis
Conduction system pacing vs. biventricular pacing for cardiac resynchronization therapy in heart failure: a systematic review and meta-analysis considering randomized controlled trials and observational studies
- Systematic review and meta-analysis of randomised controlled trials and observational studies
- random-effects restricted maximum likelihood models
Authors' conclusion
Randomized evidence demonstrates no significant difference between CSP and BiVP in hard clinical endpoints, despite superior electrical resynchronization and modest functional improvement with CSP.
Study context
- Population
- Patients with heart failure with reduced ejection fraction (HFrEF) receiving cardiac resynchronization therapy (CRT)25 studies (11 randomized controlled trials (RCTs), 14 observational)
- Participants
- 4,577 patients
- Comparison
- Conduction system pacing (CSP) vs biventricular pacing (BiVP) for CRT
Pooled result
As reported in the abstract
All-cause mortality and HF hospitalization (RCT-only analysis)
All-cause mortality, CSP vs BiVP, RCT-only: no significant difference (RR 0.96)
P = 0.91
Heart failure (HF) hospitalization, CSP vs BiVP, RCT-only: no significant difference (RR 0.67)
P = 0.12
Further pooled results
| Outcome | Estimate | P value |
|---|---|---|
| Paced QRS duration (RCT-only analysis) | MD −19.52 ms | P < 0.001 |
| NYHA class (RCT-only analysis) | MD −0.19 | P = 0.05 |
| All-cause mortality and HF hospitalization (combined RCT + observational analysis) — CSP vs BiVP · all-cause mortality | RR 0.74 | P = 0.004 |
| All-cause mortality and HF hospitalization (combined RCT + observational analysis) — CSP vs BiVP · HF hospitalization | RR 0.64 | P < 0.001 |
Safety
Procedural complications (RCT-only analysis)
- Procedural complications, CSP vs BiVP, RCT-only: no significant difference (RR 0.83)
- P = 0.44
Original publication
Conduction system pacing vs. biventricular pacing for cardiac resynchronization therapy in heart failure: a systematic review and meta-analysis considering randomized controlled trials and observational studies. Europace. Published 13 August 2026. doi:10.1093/europace/euag169
Summarised from the published abstract; every number is checked against it