Heart failure & cardiomyopathiesMeta-analysis
Conduction system vs. biventricular pacing in heart failure with reduced ejection fraction: a meta-analysis of randomized controlled trials
- Systematic review and meta-analysis of randomised trials
- random-effects
Searched MEDLINE, Embase, Scopus and Cochrane through 4 May 2026
Authors' conclusion
In patients with HFrEF undergoing CRT, CSP is associated with lower composite risk of HHF or all-cause mortality compared with BiVP. Conduction system pacing is also associated with improved functional capacity, without significant differences in safety or procedural outcomes.
Study context
- Population
- Patients with heart failure with reduced ejection fraction (HFrEF) undergoing cardiac resynchronization therapy (CRT)
- Participants
- 1,320 patients · 13 randomized controlled trials (RCTs)
- Comparison
- Conduction system pacing (CSP) vs biventricular pacing (BiVP)
- CSPn = 657
- BiVPn = 663reference
Pooled result
As reported in the abstract
- HF hospitalization
- All-cause mortality
Odds ratio
0.51
95% CI 0.28–0.93
Events by group
CSP
46
events
BiVP
83
events
Further pooled results
| Outcome | MD (ms) (95% CI) | |
|---|---|---|
| QRS duration | −10.94 (−17.55 to −4.34) | |
| −20−10010Difference, ms (linear scale) |
Hospitalization for heart failure (HHF) alone
- No significant difference, CSP vs BiVP
- OR 0.68, 95% CI 0.36-1.27
All-cause mortality
- No significant difference, CSP vs BiVP
- OR 0.75, 95% CI 0.36-1.58
6-min walk distance
- Greater improvement with CSP
- MD 21.53 m, 95% CI 4.33-38.73
NYHA functional class
- Greater improvement with CSP
- SMD −0.27, 95% CI −0.47 to −0.07
Quality of life
- No greater improvement with CSP
LVEF, LV end-systolic volume, pacing threshold, procedure time, fluoroscopy time
- No significant differences
Safety
Any complication, reintervention
- No significant differences
Original publication
Summarised from the published abstract; every number is checked against it