{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:28:11Z","timestamp":1789576091318,"version":"build-2803163510"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Conduction system pacing, including His bundle pacing and left bundle branch area pacing, has emerged as a physiological alternative to biventricular pacing (BiVP) for cardiac resynchronisation therapy (CRT). BiVP benefits patients with left bundle branch block (LBBB), but outcomes in non-LBBB morphologies are inconsistent. We synthesised the evidence for CSP in heart failure patients with non-LBBB conduction patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a systematic review and meta-analysis (PROSPERO CRD420251015905) of 21 studies (11 with quantitative data; n = 480). Comparative outcomes (CSP vs. BiVP) and baseline vs. follow-up CSP changes were pooled. Primary endpoints were left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), New York Heart Association (NYHA) class, and QRS duration. Secondary endpoints included heart failure hospitalisation and all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In head-to-head analyses (198 patients; 99 per arm), CSP conferred a mean + 5.83% LVEF benefit (95% CI 3.06\u20138.60;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.0001; I\n                      <jats:sup>2<\/jats:sup>\n                      = 0%), reduced LVEDD by 3.87 mm (95% CI 2.53\u20135.21;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), improved NYHA class by \u22120.30 (95% CI \u20130.46 to \u22120.13;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0004), and narrowed QRS (SMD \u20130.91; 95% CI \u20131.18 to \u22120.64;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.00001). CSP also halved HF hospitalisation risk (RR 0.44; 95% CI 0.24\u20130.81;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.008; I\n                      <jats:sup>2<\/jats:sup>\n                      = 0%). In single-arm baseline and follow-up analyses (480 patients), CSP yielded a mean + 8.91% LVEF, \u22122.95 mm LVEDD, SMD \u20131.37 NYHA, and SMD \u20131.21 QRS (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In non-LBBB heart failure, CSP delivers substantial improvements in ventricular systolic function, reverse remodelling, symptoms, and electrical synchrony versus BiVP, with reduced HF hospitalisation. These findings position CSP as a promising BiVP strategy for a traditionally non-responder subgroup and warrant confirmation in large, randomised trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphys.2025.1716337","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T05:16:50Z","timestamp":1763356610000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Efficacy and safety of conduction system pacing in heart failure patients with non-left bundle branch block morphology: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Kaung Myat","family":"Thu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Antoun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Eldesouky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Abdelrazik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"May Myat","family":"Thaint","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. 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