Conduction System Pacing Versus Biventricular Cardiac Resynchronization Pacing: Meta-Analysis on Outcomes in Patients with Non-Left Bundle Branch Block
<i>Background and Objectives</i>: The role of biventricular pacing (BVP) is less well-established in patients with heart failure with reduced ejection fraction (HFrEF) without left bundle branch block (LBBB). Conduction system pacing (CSP) has gained significant traction and may provide...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-07-01
|
| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/61/7/1240 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850071616306806784 |
|---|---|
| author | Xuanming Pung Joe J. L. Chua Khi Yung Fong Yi Yi Chua Germaine J. M. Loo Jonathan W. S. Ong Julian C. K. Tay Hooi Khee Teo Yue Wang Colin Yeo Eric T. S. Lim Kah Leng Ho Daniel T. T. Chong Chi Keong Ching Vern Hsen Tan |
| author_facet | Xuanming Pung Joe J. L. Chua Khi Yung Fong Yi Yi Chua Germaine J. M. Loo Jonathan W. S. Ong Julian C. K. Tay Hooi Khee Teo Yue Wang Colin Yeo Eric T. S. Lim Kah Leng Ho Daniel T. T. Chong Chi Keong Ching Vern Hsen Tan |
| author_sort | Xuanming Pung |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: The role of biventricular pacing (BVP) is less well-established in patients with heart failure with reduced ejection fraction (HFrEF) without left bundle branch block (LBBB). Conduction system pacing (CSP) has gained significant traction and may provide a safe and more physiological alternative to BVP in these patients. A few small studies studying this question have reported conflicting results. This meta-analysis aims to compare procedural and clinical outcomes between CSP and BVP in this group. <i>Materials and Methods</i>: An online literature search was systematically conducted to retrieve studies comparing CSP and BVP in HFrEF patients with non-LBBB. Four studies with 461 patients were included. <i>Results</i>: Implant-derived paced QRS duration was significantly shorter (mean difference [MD] −19.7 ms, 95% confidence interval [CI] −36.2 to −3.3, <i>p</i> = 0.0355) with CSP. Echocardiographic response with significantly greater improvement in left ventricular ejection fraction (MD 5.6%, 95% CI 3.1 to 8.0, <i>p</i> = 0.0106) was also observed with CSP. There were no statistically significant differences in clinical outcomes such as all-cause mortality (relative risk [RR] 0.53, 95% CI 0.18 to 1.60, <i>p</i> = 0.133) and heart failure hospitalization (RR 0.54, 95% CI 0.19 to 1.56, <i>p</i> = 0.129). <i>Conclusions</i>: This meta-analysis suggests that CSP may have better electrical synchrony and echocardiographic response compared to BVP in HFrEF patients with non-LBBB. Further randomized studies with longer follow-up may be required to elucidate potential benefits in clinical outcomes. |
| format | Article |
| id | doaj-art-93b2002a742b497da7fa92248397f50d |
| institution | DOAJ |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj-art-93b2002a742b497da7fa92248397f50d2025-08-20T02:47:17ZengMDPI AGMedicina1010-660X1648-91442025-07-01617124010.3390/medicina61071240Conduction System Pacing Versus Biventricular Cardiac Resynchronization Pacing: Meta-Analysis on Outcomes in Patients with Non-Left Bundle Branch BlockXuanming Pung0Joe J. L. Chua1Khi Yung Fong2Yi Yi Chua3Germaine J. M. Loo4Jonathan W. S. Ong5Julian C. K. Tay6Hooi Khee Teo7Yue Wang8Colin Yeo9Eric T. S. Lim10Kah Leng Ho11Daniel T. T. Chong12Chi Keong Ching13Vern Hsen Tan14Department of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of General Medicine, Changi General Hospital, Singapore 529889, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, Changi General Hospital, Singapore 529889, SingaporeDepartment of Cardiology, Changi General Hospital, Singapore 529889, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, Changi General Hospital, Singapore 529889, Singapore<i>Background and Objectives</i>: The role of biventricular pacing (BVP) is less well-established in patients with heart failure with reduced ejection fraction (HFrEF) without left bundle branch block (LBBB). Conduction system pacing (CSP) has gained significant traction and may provide a safe and more physiological alternative to BVP in these patients. A few small studies studying this question have reported conflicting results. This meta-analysis aims to compare procedural and clinical outcomes between CSP and BVP in this group. <i>Materials and Methods</i>: An online literature search was systematically conducted to retrieve studies comparing CSP and BVP in HFrEF patients with non-LBBB. Four studies with 461 patients were included. <i>Results</i>: Implant-derived paced QRS duration was significantly shorter (mean difference [MD] −19.7 ms, 95% confidence interval [CI] −36.2 to −3.3, <i>p</i> = 0.0355) with CSP. Echocardiographic response with significantly greater improvement in left ventricular ejection fraction (MD 5.6%, 95% CI 3.1 to 8.0, <i>p</i> = 0.0106) was also observed with CSP. There were no statistically significant differences in clinical outcomes such as all-cause mortality (relative risk [RR] 0.53, 95% CI 0.18 to 1.60, <i>p</i> = 0.133) and heart failure hospitalization (RR 0.54, 95% CI 0.19 to 1.56, <i>p</i> = 0.129). <i>Conclusions</i>: This meta-analysis suggests that CSP may have better electrical synchrony and echocardiographic response compared to BVP in HFrEF patients with non-LBBB. Further randomized studies with longer follow-up may be required to elucidate potential benefits in clinical outcomes.https://www.mdpi.com/1648-9144/61/7/1240conduction system pacingcardiac physiologic pacingbiventricular pacingcardiac resynchronization therapyright bundle branch blockintraventricular conduction delay |
| spellingShingle | Xuanming Pung Joe J. L. Chua Khi Yung Fong Yi Yi Chua Germaine J. M. Loo Jonathan W. S. Ong Julian C. K. Tay Hooi Khee Teo Yue Wang Colin Yeo Eric T. S. Lim Kah Leng Ho Daniel T. T. Chong Chi Keong Ching Vern Hsen Tan Conduction System Pacing Versus Biventricular Cardiac Resynchronization Pacing: Meta-Analysis on Outcomes in Patients with Non-Left Bundle Branch Block Medicina conduction system pacing cardiac physiologic pacing biventricular pacing cardiac resynchronization therapy right bundle branch block intraventricular conduction delay |
| title | Conduction System Pacing Versus Biventricular Cardiac Resynchronization Pacing: Meta-Analysis on Outcomes in Patients with Non-Left Bundle Branch Block |
| title_full | Conduction System Pacing Versus Biventricular Cardiac Resynchronization Pacing: Meta-Analysis on Outcomes in Patients with Non-Left Bundle Branch Block |
| title_fullStr | Conduction System Pacing Versus Biventricular Cardiac Resynchronization Pacing: Meta-Analysis on Outcomes in Patients with Non-Left Bundle Branch Block |
| title_full_unstemmed | Conduction System Pacing Versus Biventricular Cardiac Resynchronization Pacing: Meta-Analysis on Outcomes in Patients with Non-Left Bundle Branch Block |
| title_short | Conduction System Pacing Versus Biventricular Cardiac Resynchronization Pacing: Meta-Analysis on Outcomes in Patients with Non-Left Bundle Branch Block |
| title_sort | conduction system pacing versus biventricular cardiac resynchronization pacing meta analysis on outcomes in patients with non left bundle branch block |
| topic | conduction system pacing cardiac physiologic pacing biventricular pacing cardiac resynchronization therapy right bundle branch block intraventricular conduction delay |
| url | https://www.mdpi.com/1648-9144/61/7/1240 |
| work_keys_str_mv | AT xuanmingpung conductionsystempacingversusbiventricularcardiacresynchronizationpacingmetaanalysisonoutcomesinpatientswithnonleftbundlebranchblock AT joejlchua conductionsystempacingversusbiventricularcardiacresynchronizationpacingmetaanalysisonoutcomesinpatientswithnonleftbundlebranchblock AT khiyungfong conductionsystempacingversusbiventricularcardiacresynchronizationpacingmetaanalysisonoutcomesinpatientswithnonleftbundlebranchblock AT yiyichua conductionsystempacingversusbiventricularcardiacresynchronizationpacingmetaanalysisonoutcomesinpatientswithnonleftbundlebranchblock AT germainejmloo conductionsystempacingversusbiventricularcardiacresynchronizationpacingmetaanalysisonoutcomesinpatientswithnonleftbundlebranchblock AT jonathanwsong conductionsystempacingversusbiventricularcardiacresynchronizationpacingmetaanalysisonoutcomesinpatientswithnonleftbundlebranchblock AT juliancktay conductionsystempacingversusbiventricularcardiacresynchronizationpacingmetaanalysisonoutcomesinpatientswithnonleftbundlebranchblock AT hooikheeteo conductionsystempacingversusbiventricularcardiacresynchronizationpacingmetaanalysisonoutcomesinpatientswithnonleftbundlebranchblock AT yuewang conductionsystempacingversusbiventricularcardiacresynchronizationpacingmetaanalysisonoutcomesinpatientswithnonleftbundlebranchblock AT colinyeo conductionsystempacingversusbiventricularcardiacresynchronizationpacingmetaanalysisonoutcomesinpatientswithnonleftbundlebranchblock AT erictslim conductionsystempacingversusbiventricularcardiacresynchronizationpacingmetaanalysisonoutcomesinpatientswithnonleftbundlebranchblock AT kahlengho conductionsystempacingversusbiventricularcardiacresynchronizationpacingmetaanalysisonoutcomesinpatientswithnonleftbundlebranchblock AT danielttchong conductionsystempacingversusbiventricularcardiacresynchronizationpacingmetaanalysisonoutcomesinpatientswithnonleftbundlebranchblock AT chikeongching conductionsystempacingversusbiventricularcardiacresynchronizationpacingmetaanalysisonoutcomesinpatientswithnonleftbundlebranchblock AT vernhsentan conductionsystempacingversusbiventricularcardiacresynchronizationpacingmetaanalysisonoutcomesinpatientswithnonleftbundlebranchblock |