Observational studyHeart rhythm2025
Conduction system pacing compared with biventricular pacing for cardiac resynchronization therapy in patients with heart failure and mildly reduced left ventricular ejection fraction: Results from International Collaborative LBBAP Study (I-CLAS) Group.
Observational study in Heart rhythm, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Conduction System Pacing Versus Biventricular Cardiac Resynchronization in HFmrEF: A Systematic Review and Meta-Analysis.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2026Pooled it
- Top developments in clinical cardiac electrophysiology-2025.Heart rhythm O2 · 2026Review
- The Barthel Index in Predicting Response to Cardiac Resynchronization Therapy and Clinical Outcomes in Patients With Heart Failure.Clinical cardiology · 2026Observational
- The Resynchronization Effect in Left Bundle Branch Pacing Can be Evaluated Non-Invasively With the Implementation of Lead V8.Journal of cardiovascular electrophysiology · 2026Article
- Cardiac Resynchronization Therapy: A Review.JAMA · 2026Review
- Left bundle branch area pacing vs right ventricular pacing for atrioventricular block: the MELOS RELOADED study.European heart journal · 2026Article
- Physiologic Pacing in Heart Failure.The New England journal of medicine · 2026Review
- Conduction system pacing compared with biventricular pacing for cardiac resynchronization therapy: a systematic review and meta-analysis.Frontiers in cardiovascular medicine · 2026Review
- Transitioning into the new era of conduction system pacing (CSP): a district general hospital experience.The British journal of cardiology · 2026Article
- Left bundle branch pacing in patients with structural heart disease: personalizing cardiac resynchronization therapy.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Review
- Observational
- Cardiac Resynchronization Therapy and Conduction System Pacing.Journal of clinical medicine · 2025Review
- European Society of Cardiology (ESC) clinical consensus statement on indications for conduction system pacing, with special contribution of the European Heart Rhythm Association of the ESC and endorsed by the Asia Pacific Heart Rhythm Society, the Canadian Heart Rhythm Society, the Heart Rhythm Society, and the Latin American Heart Rhythm Society.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Article
Corrections and comments
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Authors and funding
28 authors.
Funding
Abstract
backgroundCardiac resynchronization therapy (CRT) is a guideline-recommended therapy in patients with heart failure with mildly reduced ejection fraction (HFmrEF, 36%-50%) and left bundle branch block or indication for ventricular pacing. Conduction system pacing (CSP) using left bundle branch area pacing or His bundle pacing has been shown to be a safe and physiologic alternative to biventricular pacing (BVP).
objectiveThe aim of this study was to compare the clinical outcomes between BVP and CSP for patients with HFmrEF undergoing CRT.
methodsConsecutive patients who underwent BVP or CSP with HFmrEF between January 2018 and June 2023 at 16 international centers were included. The primary outcome was the composite end point of time to death or heart failure hospitalization (HFH). Secondary end points included change in left ventricular ejection fraction (LVEF) and individual end points of death and HFH.
resultsA total of 1004 patients met inclusion criteria: BVP, 178; CSP, 826 (His bundle pacing, 154; left bundle branch area pacing, 672). Mean age was 73 ± 13 years; female, 34%; and LVEF, 42% ± 5%. Paced QRS duration in CSP was significantly narrower compared with BVP (129 ± 21 ms vs 144 ± 19 ms; P < .001). LVEF improved during follow-up in both groups (49% ± 10% vs 48% ± 10%; P = .32). CSP was independently associated with significant reduction in the primary end point of time to death or HFH compared with BVP (22% vs 34%; hazard ratio, 0.64; 95% confidence interval, 0.43-0.94; P = .025).
conclusionCSP was associated with improved clinical outcomes compared with BVP in this large cohort of patients with HFmrEF undergoing CRT. Randomized controlled trials comparing CSP with BVP will be necessary to confirm these results.
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