{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T03:51:18Z","timestamp":1791258678475,"version":"4.1.0"},"reference-count":42,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"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":["Pacing Clinical Electrophis"],"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\u2010system pacing (CSP) has emerged as a physiological alternative to conventional biventricular pacing (BiVP) for cardiac resynchronization therapy (CRT) in patients with heart failure with reduced ejection fraction (HFrEF). However, whether CSP provides superior clinical, echocardiographic, procedural, or safety outcomes compared with BiVP remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review, pairwise meta\u2010analysis, and frequentist network meta\u2010analysis of randomized controlled trials comparing CSP with BiVP in adults with HFrEF undergoing CRT. PubMed\/MEDLINE, Embase, Scopus, Web of Science, and CENTRAL were searched from inception to May 5, 2026. The primary outcomes were change in left ventricular ejection fraction (LVEF), heart\u2010failure hospitalization, and all\u2010cause mortality. Secondary outcomes included NYHA functional class, QRS duration, ventricular volumes, procedural metrics, echocardiographic response, feasibility, device\u2010related outcomes, and safety. Risk ratios or mean differences with 95% confidence intervals were pooled using random\u2010effects models. Network meta\u2010analysis compared individual pacing strategies, including His\u2010bundle pacing (HBP), left bundle branch area\/left bundle branch pacing, mixed CSP, and BiVP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nine randomized controlled trials including 976 participants were analyzed. Compared with BiVP, CSP was not associated with a statistically significant improvement in LVEF (MD, 1.90 percentage points; 95% CI, \u22121.05 to 4.86;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.176), heart\u2010failure hospitalization (RR, 0.83; 95% CI, 0.31 to 2.22;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.660), or all\u2010cause mortality (RR, 1.05; 95% CI, 0.40 to 2.70;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.900). Network meta\u2010analysis showed no statistically significant superiority of any individual CSP modality over BiVP for the primary outcomes. CSP was associated with a modest improvement in NYHA functional class (MD, \u22120.17; 95% CI, \u22120.34 to \u22120.00;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.049), but no significant differences were observed in QRS duration, LVESV, LVEDV, pacing threshold, procedural time, fluoroscopy time, echocardiographic response, procedural success, complications, lead revision, infection or explantation, crossover, or ventricular arrhythmias requiring ICD therapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In randomized evidence, CSP was not consistently superior to BiVP for LVEF improvement, heart\u2010failure hospitalization, mortality, ventricular remodeling, procedural outcomes, or safety in patients with HFrEF undergoing CRT. CSP may represent a feasible physiological alternative in selected patients and experienced centers, but BiVP remains the established default strategy. Larger randomized trials with standardized CSP capture criteria, longer follow\u2010up, and adequately powered clinical endpoints are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70357","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T07:20:05Z","timestamp":1783495205000},"page":"1519-1539","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Conduction\u2010System Versus Biventricular Pacing for CRT in HFrEF: Pairwise and Network Meta\u2010Analysis"],"prefix":"10.1111","volume":"49","author":[{"given":"Mustafa","family":"Abomohsen","sequence":"first","affiliation":[{"name":"Cardiology Department Brookdale University Hospital and Medical Center  Brooklyn New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9457-9832","authenticated-orcid":false,"given":"Mohamed","family":"Rifai","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Menoufia University  Shibin al Kawm Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azad","family":"Mojahedi","sequence":"additional","affiliation":[{"name":"Cardiology Department Brookdale University Hospital and Medical Center  Brooklyn New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hager Mohamed","family":"Bakr","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Menoufia University  Shibin al Kawm Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohanad A.","family":"Alkuwaiti","sequence":"additional","affiliation":[{"name":"College of Medicine Imam Abdulrahman Bin Faisal University  Dammam Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3080-2875","authenticated-orcid":false,"given":"Mohamed S.","family":"Elgendy","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Tanta University  Tanta Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed A.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Menoufia University  Shibin al Kawm Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed A.","family":"Sabeha","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Menoufia University  Shibin al Kawm Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdallah Montaser","family":"Salman","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Menoufia University  Shibin al Kawm Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iyad Y.","family":"Idries","sequence":"additional","affiliation":[{"name":"Cardiology Department Brookdale University Hospital and Medical Center  Brooklyn New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moshe","family":"Gunsburg","sequence":"additional","affiliation":[{"name":"Cardiology Department Brookdale University Hospital and Medical Center  Brooklyn New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"issue":"1","key":"e_1_2_11_2_1","first-page":"4","article-title":"Global Burden of Heart Failure: A Comprehensive and Contemporary Review","volume":"25","author":"Savarese G.","year":"2023","journal-title":"European Journal of Heart Failure"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.15420\/cfr.2023.03"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2024.07.001"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.12.012"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa013168"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032423"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa050496"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.08.027"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009540"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad195"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.15420\/aer.2024.10"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2025.03.024"},{"issue":"3","key":"e_1_2_11_15_1","first-page":"102","article-title":"Left Bundle Branch Pacing: A Promising Modality for Cardiac Resynchronisation Therapy","volume":"31","author":"Luermans J. G.","year":"2023","journal-title":"Netherlands Heart Journal"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2024.1495689"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.8.869"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.2010.02951.x"},{"issue":"12","key":"e_1_2_11_19_1","first-page":"e7","article-title":"A Novel Pacing Strategy With Low and Stable Output: Pacing of Left Bundle Branch","volume":"14","author":"Huang W.","year":"2017","journal-title":"Heart Rhythm"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.1062372"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2023.03.1538"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2024.02.035"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hsr.2023.100104"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina61071240"},{"issue":"6","key":"e_1_2_11_25_1","first-page":"791","article-title":"His Corrective Pacing or Biventricular Pacing for Cardiac Resynchronization in Heart Failure (His\u2010SYNC pilot trial)","volume":"16","author":"Upadhyay G. A.","year":"2019","journal-title":"Heart Rhythm"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2021.04.003"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2026.0083"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehag225"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2026.0101"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2023.08.003"},{"key":"e_1_2_11_31_1","unstructured":"D.\u017di\u017eek B.Antoli\u010d A. Z.Me\u017enar et\u00a0al. Biventricular versus conduction system pacing for CRT in patients with left bundle branch block: CSP\u2010SYNC randomised trial(2025)."},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.07.019"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2385"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_11_36_1","unstructured":"R Core Team.R: A language and environment for statistical computing.R Foundation for Statistical Computing;2025."},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1136\/ebmental-2019-300117"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v036.i03"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v106.i02"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-015-0060-8"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1167"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.57"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.03.013"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70357","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70357","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70357","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T03:12:39Z","timestamp":1791256359000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70357"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":42,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/pace.70357"],"URL":"https:\/\/doi.org\/10.1111\/pace.70357","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]},"assertion":[{"value":"2026-03-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}