Conduction system vs. biventricular pacing in heart failure with reduced ejection fraction: a meta-analysis of randomized controlled trials.
P, K., K, V., KC, S., Ó, C., S, T., M, S., K, P., G, L., AP, A., & P, J. (2026). Conduction system vs. biventricular pacing in heart failure with reduced ejection fraction: a meta-analysis of randomized controlled trials.. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working grou. https://doi.org/10.1093/europace/euag170
P K, K V, KC S, Ó C, S T, M S, et al. Conduction system vs. biventricular pacing in heart failure with reduced ejection fraction: a meta-analysis of randomized controlled trials.. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working grou. 2026; doi: 10.1093/europace/euag170
P K, K V, KC S, et al. Conduction system vs. biventricular pacing in heart failure with reduced ejection fraction: a meta-analysis of randomized controlled trials.[J]. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working grou. 2026. DOI: 10.1093/europace/euag170.
@article{p2026,
author = {Karakasis P and Vlachos K and Siontis KC and Cano Ó and Tzeis S and Strik M and Pamporis K and Leventopoulos G and Antoniadis AP and Jaïs P},
title = {Conduction system vs. biventricular pacing in heart failure with reduced ejection fraction: a meta-analysis of randomized controlled trials.},
journal = {Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working grou},
year = {2026},
doi = {10.1093/europace/euag170},
note = {PMID: 42586561},
}
TY - JOUR AU - Karakasis P AU - Vlachos K AU - Siontis KC AU - Cano Ó AU - Tzeis S AU - Strik M AU - Pamporis K AU - Leventopoulos G AU - Antoniadis AP AU - Jaïs P TI - Conduction system vs. biventricular pacing in heart failure with reduced ejection fraction: a meta-analysis of randomized controlled trials. T2 - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working grou PY - 2026 DO - 10.1093/europace/euag170 AN - PMID:42586561 ER -
AIMS: Conduction system pacing (CSP) has emerged as a physiologic alternative to cardiac resynchronization therapy (CRT) with biventricular pacing (BiVP) in heart failure with reduced ejection fraction (HFrEF), yet its comparative effects remain uncertain. This meta-analysis sought to compare outcomes of CSP vs. BiVP in patients with HFrEF undergoing CRT. METHODS AND RESULTS: MEDLINE, Embase, Scopus, and the Cochrane Database were searched through 4 May 2026. Randomized controlled trials (RCTs) were synthesized using random-effects meta-analysis. Thirteen RCTs including 1320 participants were analysed (657 CSP, 663 BiVP). Conduction system pacing was associated with a lower risk of the composite of hospitalization for heart failure (HHF) or all-cause mortality compared with BiVP (46 vs. 83 events; odds ratio [OR] 0.51, 95% confidence interval [CI] 0.28-0.93). No significant differences were observed for HHF alone (OR 0.68, 95% CI 0.36-1.27) or all-cause mortality (OR 0.75, 95% CI 0.36-1.58). Conduction system pacing was associated with greater improvement in the 6-min walk distance (mean difference [MD] 21.53 m, 95% CI 4.33-38.73) and New York Heart Association functional class (standardized mean difference [SMD] -0.27, 95% CI -0.47 to -0.07), but not quality of life. Conduction system pacing also reduced QRS duration compared with BiVP (MD -10.94 ms, 95% CI -17.55 to -4.34), with no significant differences in left ventricular ejection fraction, left ventricular end-systolic volume, overall pacing threshold, total procedure time, fluoroscopy time, any complication, or reintervention. 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.