Conduction-System Versus Biventricular Pacing for CRT in HFrEF: Pairwise and Network Meta-Analysis.
Mustafa Abomohsen, Mohamed Rifai, Azad Mojahedi et al.
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In 30 seconds
This network meta-analysis evaluated conduction-system pacing (CSP) versus biventricular pacing (BiVP) in adults with heart failure and reduced ejection fraction (HFrEF). Analyzing nine randomized controlled trials with 976 participants, the study found no significant differences in left ventricular ejection fraction (LVEF), heart-failure hospitalization, or all-cause mortality between CSP and BiVP. CSP showed a modest improvement in NYHA functional class.
Key findings
- CSP did not significantly improve LVEF compared to BiVP (MD, 1.90 percentage points; p = 0.176).
- No significant difference in heart-failure hospitalization rates between CSP and BiVP (RR, 0.83; p = 0.660).
- CSP was associated with a modest improvement in NYHA functional class (MD, -0.17; p = 0.049).
- No significant differences in procedural outcomes or safety metrics were observed.
Why it matters
Understanding the comparative effectiveness of CSP and BiVP is crucial for optimizing cardiac resynchronization therapy in patients with HFrEF. This analysis informs clinicians about the current evidence regarding these pacing strategies.