Heart failure & cardiomyopathies
Improved outcomes of conduction system pacing in heart failure with reduced ejection fraction: A systematic review and meta-analysis
Authors' conclusion
Overall, both CSP techniques are feasible and effective CRT alternatives for heart failure.
Study context
- Population
- Patients with HF and cardiac resynchronization therapy (CRT) indications15 randomized controlled trials (RCTs) and non-RCTs
- Comparison
- Conduction system pacing (CSP) vs biventricular pacing (BVP) for CRT
- Outcome
- QRS duration, LVEF and NYHA class score (mean differences)
Pooled result
As reported in the abstract
CSP vs BVPMean difference, ms (95% CI)P value
QRS duration; I2= 87.1%
−20.3(−26.1 to −14.5)
P < 0.05CSP vs BVPWeighted mean increase, % (95% CI)P value
LVEF; I2 = 55.6
5.2(3.5%–6.9%)
P < 0.05CSP vs BVPMean difference (95% CI)P value
NYHA score; I2 = 61.7
−0.40(−0.6 to −0.2)
P < 0.05Further pooled results
| Outcome | Mean pacing threshold (V) (95% CI) |
|---|---|
| Pacing threshold, by CSP modality (subgroup)LBBAP vs BVP · significantly lowered · associated with significant heterogeneity | −0.51 (−0.68 to −0.38) |
| Pacing threshold, by CSP modality (subgroup)HBP vs BVP · increased · associated with significant heterogeneity | 0.62 (−0.03 to 1.26) |
QRS duration (QRSd) and left ventricular ejection fraction (LVEF), by CSP modality (subgroup)
- Significant weighted mean improvements of QRSd and LVEF with both left bundle branch area pacing (LBBAP) and His bundle pacing (HBP) vs BVP
New York Heart Association (NYHA) class, by CSP modality (subgroup)
- LBBAP improved NYHA vs BVP, without differences between CSP subgroups
Original publication
Improved outcomes of conduction system pacing in heart failure with reduced ejection fraction: A systematic review and meta-analysis. Heart Rhythm. Published 10 May 2023. doi:10.
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