Conduction system pacing compared with biventricular pacing for cardiac resynchronization therapy: a systematic review and meta-analysis - Summary - MDSpire
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Conduction system pacing compared with biventricular pacing for cardiac resynchronization therapy: a systematic review and meta-analysis
To compare the clinical efficacy and safety of conduction system pacing (CSP) and biventricular pacing (BVP) in cardiac resynchronization therapy (CRT) for patients with heart failure with reduced ejection fraction (HFrEF).
Key Findings:
CSP showed greater improvement in LVEF (MD: 4.22%, 95%CI: 2.74%–5.70%) compared to BVP.
CSP resulted in better NYHA class (MD: -0.34, 95%CI: -0.47 to -0.21) and QRS narrowing (MD: -19.60 ms, 95%CI: -24.18 to -15.02 ms).
CSP increased super-response (RR: 1.86, 95%CI: 1.43–2.43) and had shorter fluoroscopy time (MD: -5.04 min, 95%CI: -8.62 to -1.45 min).
ACM was comparable between CSP and BVP (RR: 0.87, 95%CI: 0.62–1.22).
Interpretation:
CSP may provide superior echocardiographic and electrocardiographic outcomes compared to BVP, but the overall certainty of the evidence is low to very low, indicating caution in clinical application.
Limitations:
Publication bias detected for LVEF.
Low to very low certainty of evidence as per GRADE assessment.
Current findings highlight the urgent need for large-scale, adequately powered RCTs to validate these results.
Conclusion:
CSP may offer advantages over BVP in CRT, but further research is necessary to confirm these potential benefits.
