{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T13:41:06Z","timestamp":1792590066179,"version":"4.5.0"},"reference-count":22,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Arrhythmia"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Conduction system pacing (CSP) is an emerging alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT). Recent randomized controlled trials (RCTs) have yielded divergent results, creating uncertainty about the comparative effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a systematic review and meta\u2010analysis of RCTs comparing CSP with BVP for CRT, searching PubMed, Embase, and CENTRAL through May 2026 (updating a prior review). The primary outcome was change in left ventricular ejection fraction (\u0394LVEF), analyzed with random\u2010effects models and prediction intervals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eight parallel\u2010group RCTs including 799 patients (396 CSP, 403 BVP) were included. Pooled \u0394LVEF did not differ significantly (MD +2.40%, 95% CI \u22120.49 to 5.29,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.091;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200975%). CSP showed a non\u2010significant trend toward shorter paced QRS (MD \u22127.6\u2009ms,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.14) and improved NYHA class (SMD \u22120.33,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.12). Heart failure hospitalization (RR 0.69), mortality (RR 1.17), complications (RR 0.84), and procedure time did not differ. The four trials enrolling exclusively LBBB patients favored CSP (MD +5.00%, 95% CI 3.01 to 6.98,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%), consistent in the three using confirmed LBBAP\/LBBP (MD +5.37%, 95% CI 3.23 to 7.52,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this analysis of randomized trials of CRT, no statistically significant difference was observed between CSP and BVP for any outcome. Because no non\u2010inferiority margin was prespecified and the clinical\u2010event analyses were underpowered, these findings should not be interpreted as establishing equivalence or comparable safety. Exploratory analyses suggest that patients with LBBB undergoing LBBAP\/LBBP may derive incremental benefit, warranting confirmation in adequately powered trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/joa3.70500","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T12:57:18Z","timestamp":1792587438000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Conduction System Pacing Versus Biventricular Pacing for Cardiac Resynchronization Therapy: A Systematic Review and Meta\u2010Analysis of Randomized Controlled Trials"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9635-7658","authenticated-orcid":false,"given":"Shreyas","family":"Singireddy","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine University of Illinois College of Medicine at Peoria  Peoria Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5015-0814","authenticated-orcid":false,"given":"Sami","family":"Shoura","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine University of Illinois College of Medicine at Peoria  Peoria Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6134-0586","authenticated-orcid":false,"given":"Darshine","family":"Venugopal","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine University of Illinois College of Medicine at Peoria  Peoria Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7078-6960","authenticated-orcid":false,"given":"Ragavendar","family":"Saravanabavanandan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine University of Illinois College of Medicine at Peoria  Peoria Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Coombes","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine University of Illinois College of Medicine at Peoria  Peoria Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timir","family":"Baman","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine University of Illinois College of Medicine at Peoria  Peoria Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8702-3026","authenticated-orcid":false,"given":"Siddharth","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine University of Illinois College of Medicine at Peoria  Peoria Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"issue":"35","key":"e_1_2_11_2_1","first-page":"3427","article-title":"ESC Guidelines on Cardiac Pacing and CRT","volume":"42","author":"Glikson M.","year":"2021","journal-title":"European Heart Journal"},{"issue":"17","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"e263","DOI":"10.1016\/j.jacc.2021.12.012","article-title":"AHA\/ACC\/HFSA Guideline for Heart Failure Management","volume":"79","author":"Heidenreich P. A.","year":"2022","journal-title":"Journal of the American College of Cardiology"},{"issue":"19","key":"e_1_2_11_4_1","first-page":"1463","article-title":"Avoiding Non\u2010Responders to CRT","volume":"38","author":"Daubert C.","year":"2017","journal-title":"European Heart Journal"},{"issue":"5","key":"e_1_2_11_5_1","first-page":"681","article-title":"HRS\/APHRS\/LAHRS Guideline on Cardiac Physiologic Pacing","volume":"39","author":"Chung M. K.","year":"2023","journal-title":"Journal of Arrhythmia"},{"issue":"11","key":"e_1_2_11_6_1","first-page":"2358","article-title":"Cardiac Conduction System Pacing: A Comprehensive Update","volume":"9","author":"Vijayaraman P.","year":"2023","journal-title":"JACC: Clinical Electrophysiology"},{"issue":"13","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1016\/j.jacc.2022.07.019","article-title":"Randomized Trial of Left Bundle Branch Vs Biventricular Pacing for CRT","volume":"80","author":"Wang Y.","year":"2022","journal-title":"Journal of the American College of Cardiology"},{"issue":"9","key":"e_1_2_11_8_1","article-title":"CSP Vs BVP for CRT: The CSP\u2010SYNC Study","volume":"27","author":"\u017di\u017eek D.","year":"2025","journal-title":"Europace"},{"issue":"4","key":"e_1_2_11_9_1","first-page":"352","article-title":"HeartSync\u2010LBBP Trial","volume":"11","author":"Chen X.","year":"2026","journal-title":"JAMA Cardiology"},{"issue":"4","key":"e_1_2_11_10_1","first-page":"360","article-title":"PhysioSync\u2010HF Trial","volume":"11","author":"Zimerman A.","year":"2026","journal-title":"JAMA Cardiology"},{"issue":"6","key":"e_1_2_11_11_1","first-page":"881","article-title":"CSP Vs BiVP in CRT: Systematic Review and Meta\u2010Analysis","volume":"21","author":"Felix F.","year":"2024","journal-title":"Heart Rhythm"},{"issue":"8","key":"e_1_2_11_12_1","first-page":"1820","article-title":"CONSYST\u2010CRT Trial","volume":"11","author":"Pujol\u2010L\u00f3pez M.","year":"2025","journal-title":"JACC: Clinical Electrophysiology"},{"issue":"11","key":"e_1_2_11_13_1","first-page":"1431","article-title":"LEVEL\u2010AT Trial","volume":"8","author":"Pujol\u2010Lopez M.","year":"2022","journal-title":"JACC: Clinical Electrophysiology"},{"issue":"1","key":"e_1_2_11_14_1","first-page":"157","article-title":"His Corrective Pacing or BVP for CRT","volume":"74","author":"Upadhyay G. A.","year":"2019","journal-title":"Journal of the American College of Cardiology"},{"issue":"24","key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"3875","DOI":"10.1002\/sim.1009","article-title":"A Refined Method for Meta\u2010Analysis of Controlled Clinical Trials","volume":"20","author":"Hartung J.","year":"2001","journal-title":"Statistics in Medicine"},{"issue":"7","key":"e_1_2_11_16_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-010247","article-title":"Plea for Routinely Presenting Prediction Intervals","volume":"6","author":"IntHout J.","year":"2016","journal-title":"BMJ Open"},{"key":"e_1_2_11_17_1","article-title":"Recommendations for Funnel Plot Examination","volume":"343","author":"Sterne J. A. C.","year":"2011","journal-title":"BMJ"},{"issue":"11","key":"e_1_2_11_18_1","first-page":"1422","article-title":"His\u2010Alternative Trial","volume":"7","author":"Vinther M.","year":"2021","journal-title":"JACC: Clinical Electrophysiology"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2026.02.016"},{"issue":"12","key":"e_1_2_11_20_1","first-page":"2628","article-title":"HOT\u2010CRT Trial","volume":"9","author":"Vijayaraman P.","year":"2023","journal-title":"JACC: Clinical Electrophysiology"},{"issue":"7","key":"e_1_2_11_21_1","first-page":"1548","article-title":"His\u2010Bundle Pacing Vs BVP: Crossover Comparison","volume":"12","author":"Lustgarten D. L.","year":"2015","journal-title":"Heart Rhythm"},{"issue":"12","key":"e_1_2_11_22_1","first-page":"1948","article-title":"ALTERNATIVE\u2010AF Trial","volume":"19","author":"Huang W.","year":"2022","journal-title":"Heart Rhythm"},{"issue":"3","key":"e_1_2_11_23_1","doi-asserted-by":"crossref","DOI":"10.1002\/joa3.70359","article-title":"Left Bundle Branch Area Pacing Vs Biventricular Pacing for Cardiac Resynchronization: Propensity Score Analysis","volume":"42","author":"Kerkouri F.","year":"2026","journal-title":"Journal of Arrhythmia"}],"container-title":["Journal of Arrhythmia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/joa3.70500","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/joa3.70500","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/joa3.70500","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T12:57:22Z","timestamp":1792587442000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/joa3.70500"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":22,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/joa3.70500"],"URL":"https:\/\/doi.org\/10.1002\/joa3.70500","archive":["Portico"],"relation":{},"ISSN":["1880-4276","1883-2148"],"issn-type":[{"value":"1880-4276","type":"print"},{"value":"1883-2148","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-06-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70500"}}