Evidence map›Paper›PMID 42586562›Full record

SynthesisEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2026

Conduction system pacing vs. biventricular pacing for cardiac resynchronization therapy in heart failure: a systematic review and meta-analysis considering randomized controlled trials and observational studies.

Karanjeet Chauhan, Marwan Shawki, Thalys Sampaio Rodrigues, Han S Lim, Geoffrey R Wong, Nathaniel M Hawkins, Gareth Wynn

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in 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, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Decoding the evidence emerging from the studies comparing conduction system pacing with conventional 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 · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Karanjeet ChauhanDepartment of Cardiology, Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria 3050, Australia.ORCID 0000-0001-7152-0220
Marwan ShawkiDepartment of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.ORCID 0000-0001-6053-5523
Thalys Sampaio RodriguesDepartment of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.ORCID 0000-0003-2302-5588
Han S LimDepartment of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.
Geoffrey R WongDepartment of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.ORCID 0000-0002-9733-7712
Nathaniel M HawkinsDepartment of Cardiology, University of British Columbia, Vancouver, Canada.ORCID 0000-0003-1286-2014
Gareth WynnDepartment of Cardiology, Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria 3050, Australia.ORCID 0000-0002-1935-8155

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsBiventricular pacing (BiVP) is the gold standard for cardiac resynchronization therapy (CRT) in heart failure with reduced ejection fraction (HFrEF), yet up to 30% of patients fail to respond. Conduction system pacing (CSP) has emerged as an alternative with potential for physiological superiority. Multiple 2026 multicentre randomized controlled trials (RCTs) reported contradictory results, necessitating an updated meta-analysis. This analysis aims to compare the safety and efficacy of CSP vs. BiVP for CRT in patients with HFrEF. METHODS AND

resultsPubMed, Cochrane CENTRAL, and Embase were searched (January 2010-May 2026) for RCTs and observational studies. Pooled risk ratios (RRs) and mean differences (MDs) were estimated using random-effects restricted maximum likelihood models. Twenty-five studies (11 RCTs, n = 1201; 14 observational, n = 3376) involving 4577 participants were included. In the RCT-only analysis, no significant differences were found in all-cause mortality (RR 0.96; P = 0.91), heart failure (HF) hospitalization (RR 0.67; P = 0.12), or procedural complications (RR 0.83; P = 0.44). Conduction system pacing significantly shortened paced QRS duration (MD -19.52 ms, P < 0.001) and improved New York Heart Association (NYHA) class (MD -0.19, P = 0.05). Combined analysis showed larger effect sizes, including lower all-cause mortality (RR 0.74; P = 0.004) and HF hospitalization (RR 0.64; P < 0.001) in the CSP group.

conclusionRandomized evidence demonstrates no significant difference between CSP and BiVP in hard clinical endpoints, despite superior electrical resynchronization and modest functional improvement with CSP. Confirmation of any clinical superiority of CSP awaits adequately powered trials reporting objective outcomes.

Indexed as

Cardiac Resynchronization TherapyHeart Conduction SystemHeart FailureHumansObservational Studies as TopicRandomized Controlled Trials as TopicStroke VolumeTreatment OutcomeBiventricular pacingCardiac resynchronization therapyConduction system pacingHeart failureLeft bundle branch pacing

Identifiers

PMID42586562
PMCPMC13466946

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.