SynthesisFrontiers in cardiovascular medicine2025
Left bundle branch area pacing vs. biventricular pacing significantly improves clinical outcomes and cardiac remodeling in cardiac resynchronization therapy: a systematic review and meta-analysis.
Synthesis in Frontiers in cardiovascular medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07604727 (AV Nodal Ablation With Conduction System Pacing Versus Cardiac Resynchronization for Symptomatic Heart Failure Patients With Atrial Fibrillation), which is not on this map. Cited by 2 papers.
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.
AV Nodal Ablation With Conduction System Pacing Versus Cardiac Resynchronization for Symptomatic Heart Failure Patients With Atrial Fibrillation: The APAF-CSP All-cause Mortality and Quality of Life Trial
Who cites it
2 citing papers in PubMed.
- True Left Bundle Branch Block by Strauss Criteria: Impact on CRT Response and Conduction System Pacing Trial Design-A Systematic Evidence Synthesis Toward Personalized Patient Selection.Journal of personalized medicine · 2026Review
- Comparative Outcomes of Left Bundle Branch Pacing and Biventricular Pacing for Cardiac Resynchronization Therapy in Heart Failure with Reduced Ejection Fraction.Diagnostics (Basel, Switzerland) · 2026Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Biventricular pacing (BiVP) is the conventional approach for cardiac resynchronization therapy (CRT), yet approximately one-third of patients show no clinical response. Left bundle branch area pacing (LBBAP) enables more physiological ventricular activation through His-Purkinje conduction, but its impact on key clinical endpoints such as all-cause mortality and heart failure hospitalization (HFH) remains debated. Methods: A systematic search of PubMed, Embase, Cochrane Library, and CNKI (to May 3, 2025) identified 24 studies encompassing 6,538 patients. Study quality was assessed using Cochrane RoB 2.0 and the Newcastle-Ottawa Scale. Subgroup analyses (by follow-up duration, study design, and sex), leave-one-out sensitivity analysis, and meta-regression were performed to assess result robustness and heterogeneity sources. Trim-and-fill correction was applied to adjust for potential publication bias. Results: LBBAP was associated with a markedly lower risk compared to BiVP across several clinical outcomes. Specifically, it significantly reduced the risk of the composite endpoint (HR: 0.67, 95% CI: 0.59-0.75), all-cause mortality (HR: 0.83, 95% CI: 0.71-0.96), and HFH (HR: 0.58, 95% CI: 0.50-0.67). Echocardiographic outcomes further supported LBBAP superiority, with higher rates of echocardiographic response (OR: 1.57, 95% CI: 1.36-1.81) and super-response (OR: 2.12, 95% CI: 1.62-2.76). Improvements in left ventricular ejection fraction (LVEF) were greater with LBBAP at both 3-6 months (MD: 5.31%, 95% CI: 4.63-5.99) and ≥12 months (MD: 4.43%, 95% CI: 2.27-6.60). Similarly, left ventricular end-diastolic diameter (LVEDD) reductions were more pronounced at 3-6 months (MD: -3.48 mm, 95% CI: -5.76 to -1.21) and ≥12 months (MD: -2.86 mm, 95% CI: -5.05 to -0.68). Conclusions: These findings indicate that LBBAP provides superior clinical and structural outcomes compared to BiVP in patients undergoing CRT. Large-scale, multicenter randomized controlled trials are warranted to confirm these results, assess long-term efficacy, and elucidate gender-specific variations to optimize evidence-based CRT delivery. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251055488, PROSPERO CRD420251055488.
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