{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:45:50Z","timestamp":1789753550628,"version":"4.0.1"},"reference-count":72,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Conduction system pacing (CSP) has emerged as a physiologic alternative to cardiac resynchronization therapy (CRT) with biventricular pacing (BiVP) in heart failure with reduced ejection fraction (HFrEF), yet its comparative effects remain uncertain. This meta-analysis sought to compare outcomes of CSP vs. BiVP in patients with HFrEF undergoing CRT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>MEDLINE, Embase, Scopus, and the Cochrane Database were searched through 4 May 2026. Randomized controlled trials (RCTs) were synthesized using random-effects meta-analysis. Thirteen RCTs including 1320 participants were analysed (657 CSP, 663 BiVP). Conduction system pacing was associated with a lower risk of the composite of hospitalization for heart failure (HHF) or all-cause mortality compared with BiVP (46 vs. 83 events; odds ratio [OR] 0.51, 95% confidence interval [CI] 0.28\u20130.93). No significant differences were observed for HHF alone (OR 0.68, 95% CI 0.36\u20131.27) or all-cause mortality (OR 0.75, 95% CI 0.36\u20131.58). Conduction system pacing was associated with greater improvement in the 6-min walk distance (mean difference [MD] 21.53\u2005m, 95% CI 4.33\u201338.73) and New York Heart Association functional class (standardized mean difference [SMD] \u22120.27, 95% CI \u22120.47 to \u22120.07), but not quality of life. Conduction system pacing also reduced QRS duration compared with BiVP (MD \u221210.94\u2005ms, 95% CI \u221217.55 to \u22124.34), with no significant differences in left ventricular ejection fraction, left ventricular end-systolic volume, overall pacing threshold, total procedure time, fluoroscopy time, any complication, or reintervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with HFrEF undergoing CRT, CSP is associated with lower composite risk of HHF or all-cause mortality compared with BiVP. Conduction system pacing is also associated with improved functional capacity, without significant differences in safety or procedural outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euag170","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T16:03:07Z","timestamp":1782921787000},"source":"Crossref","is-referenced-by-count":2,"title":["Conduction system vs. biventricular pacing in heart failure with reduced ejection fraction: a meta-analysis of randomized controlled trials"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3561-5713","authenticated-orcid":false,"given":"Paschalis","family":"Karakasis","sequence":"first","affiliation":[{"name":"Second Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki , Thessaloniki ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7543-3236","authenticated-orcid":false,"given":"Konstantinos","family":"Vlachos","sequence":"additional","affiliation":[{"name":"Electrophysiology and Heart Modeling Institute, IHU Liryc, INSERM U1045, Fondation Bordeaux Universit\u00e9 and Universit\u00e9 de Bordeaux , Pessac ,","place":["France"]},{"name":"Cardiac Arrhythmia Department, INSERM U1045, CHU de Bordeaux , Pessac ,","place":["France"]},{"name":"Electrophysiology Department, Hygeia Hospital , Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6658-0971","authenticated-orcid":false,"given":"Konstantinos C","family":"Siontis","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6783-0138","authenticated-orcid":false,"given":"\u00d3scar","family":"Cano","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitario y Polit\u00e9cnico La Fe , Planta 4-Torre F, Av. Fernando Abril Martorell, 106, Valencia 46026 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2007-1928","authenticated-orcid":false,"given":"Stylianos","family":"Tzeis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mitera Hospital , 6, Erythrou Stavrou Str. 151 23, Marousi, Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3348-6548","authenticated-orcid":false,"given":"Marc","family":"Strik","sequence":"additional","affiliation":[{"name":"Electrophysiology and Heart Modeling Institute, IHU Liryc, INSERM U1045, Fondation Bordeaux Universit\u00e9 and Universit\u00e9 de Bordeaux , Pessac ,","place":["France"]},{"name":"Cardio-Thoracic Unit, Bordeaux University Hospital (CHU) , Pessac ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5411-6461","authenticated-orcid":false,"given":"Konstantinos","family":"Pamporis","sequence":"additional","affiliation":[{"name":"First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital , Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3982-5101","authenticated-orcid":false,"given":"Georgios","family":"Leventopoulos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital of Patras , Patras 26504 ,","place":["Greece"]},{"name":"University Hospital Southampton NHS Foundation Trust Department of Cardiology, , Southampton ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6604-5581","authenticated-orcid":false,"given":"Antonios 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