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July 8, 2026Pacing and Clinical Electrophysiology

Conduction-system pacing fails to improve LVEF, HF hospitalization, or mortality vs biventricular pacing in HFrEF.

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Why the study?

Does conduction-system pacing improve LVEF, heart-failure hospitalization, and all-cause mortality compared to biventricular pacing in adults with HFrEF undergoing CRT?

Population

976 adults with HFrEF undergoing cardiac resynchronization therapy, pooled from 9 randomized controlled trials

Comparison

Conduction-system pacing, including His-bundle… vs Conventional biventricular pacing (BiVP)

Design

Meta-analysis

Key result

Conduction-system pacing did not significantly improve LVEF (MD 1.90; 95% CI -1.05 to 4.86; p=0.176), heart-failure hospitalization, or mortality compared with biventricular pacing in HFrEF.

Authors

MAMustafa AbomohsenMRMohamed RifaiAMAzad Mojahedi

Discussion

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Overview

CSP not superior to BiVP for LVEF or outcomes in HFrEF; reinforces BiVP as preferred resynchronization approach.

Study Design

Type

Meta-Analysis (n=976)

Structured PICO

Does conduction-system pacing improve LVEF, heart-failure hospitalization, and all-cause mortality compared to biventricular pacing in adults with HFrEF undergoing CRT?

P
Population
976 adults with HFrEF undergoing cardiac resynchronization therapy across 9 randomized controlled trials.
I
Intervention
Conduction-system pacing (CSP), including His-bundle pacing (HBP), left bundle branch area/left bundle branch pacing, and mixed CSP
C
Comparator
Conventional biventricular pacing (BiVP)
O
Outcome
Change in left ventricular ejection fraction (LVEF), heart-failure hospitalization, and all-cause mortalityhard clinical

Main Result

Mean Difference: 1.9 (95% CI -1.05–4.86)

p-value: p=0.176

In patients with HFrEF undergoing CRT, conduction-system pacing is not consistently superior to biventricular pacing for clinical or echocardiographic outcomes, supporting biventricular pacing as the established default strategy.

Limitations

  • Lack of standardized CSP capture criteria
  • Short follow-up
  • Inadequately powered clinical endpoints

Cite This Study

Abomohsen et al. (2026) conducted a meta-analysis in Heart failure with reduced ejection fraction (HFrEF) (n=976). Conduction-system pacing (CSP) vs. Conventional biventricular pacing (BiVP) was evaluated on Change in left ventricular ejection fraction (LVEF) (MD 1.90, 95% CI -1.05 to 4.86, p=0.176). Conduction-system pacing did not significantly improve LVEF (MD 1.90; 95% CI -1.05 to 4.86; p=0.176), heart-failure hospitalization, or mortality compared with biventricular pacing in HFrEF.

synapsesocial.com/papers/6a4fb9c5fd3483f3ceaaacd5https://doi.org/10.1111/pace.70357
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