Left bundle branch pacing vs biventricular pacing in heart failure patients undergoing cardiac resynchronization therapy: an updated systematic review and meta-analysis

Why clinicians should know about it

• Picked for Epidemiology (top studies of the week, 2 August 2026).

Abstract

INTRODUCTION: To compare the efficacy and safety of left bundle branch pacing (LBBP) versus biventricular pacing (BVP) in patients with heart failure undergoing cardiac resynchronization therapy (CRT), we conducted an updated systematic review and meta-analysis. METHODS: PubMed, Cochrane Library, ScienceDirect, and Embase, were searched through February 2026. Randomized controlled trials and cohort studies comparing LBBP with BVP were included. Risk of bias was assessed using RoB 2.0 for randomized trials and ROBINS-I for observational studies. Data were pooled using fixed- or random-effects models according to heterogeneity and expressed as odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI). RESULTS: Twenty-four studies (9,278 patients) were included. Compared with BVP, LBBP reduced fluoroscopy time (MD - 7.00, 95% CI - 9.99 to -4.01) and procedural duration (MD - 23.62, 95% CI - 35.29 to -11.95), with similar success rates. LBBP improved CRT response (OR 1.85, 95% CI 1.06-3.23), super-response (OR 1.56, 95% CI 1.38-1.77), QRS duration (MD -17.11 95% CI -21.02 to -13.20), and LVEF (MD 3.58, 95% CI 2.95 to 4.22). LBBP also lowered all-cause mortality (OR 0.57, 95% CI 0.48 to 0.68) and heart failure hospitalization (OR 0.50, 95% CI 0.43 to 0.57]. CONCLUSIONS: LBBP appears superior to BVP in improving electrical, structural, and clinical outcomes while maintaining comparable safety. PROTOCOL REGISTRATION NUMBER: CRD420261291248, and is available at: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261291248.

Abstract as published, via PubMed.